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Blood, Vol. 94 No. 6 (September 15), 1999: pp. 1848-1854

Unmutated Ig VH Genes Are Associated With a More Aggressive Form of Chronic Lymphocytic Leukemia

Terry J. Hamblin, Zadie Davis, Anne Gardiner, David G. Oscier, and Freda K. Stevenson

From the Department of Haematology, Royal Bournemouth Hospital, Bournemouth, UK; and the Molecular Immunology Department, Tenovus Research Laboratory, Southampton General Hospital, Southampton, UK.

Despite having several characteristics of naïve B cells, chronic lymphocytic leukemia (CLL) cells have been shown in some cases to have somatically mutated Ig variable region genes, indicating that the cell of origin has passed through the germinal center. A previous study of patients with CLL found an association between lack of somatic mutation and trisomy 12 and, therefore, possibly with a less favorable prognosis. We have sequenced the Ig VH genes of the tumor cells of 84 patients with CLL and correlated our findings with clinical features. A total of 38 cases (45.2%) showed >=  98% sequence homology with the nearest germline VH gene; 46 cases (54.8%) showed >2% somatic mutation. Unmutated VH genes were significantly associated with V1-69 and D3-3 usage, with atypical morphology; isolated trisomy 12, advanced stage and progressive disease. Survival was significantly worse for patients with unmutated VH genes irrespective of stage. Median survival for stage A patients with unmutated VH genes was 95 months compared with 293 months for patients whose tumors had mutated VH genes (P = .0008). The simplest explanation is that CLL comprises 2 different diseases with different clinical courses. One, arising from a memory B cell, has a benign course, the other, arising from a naïve B cell, is more malignant.


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S. G. Agrawal, F.-T. Liu, C. Wiseman, S. Shirali, H. Liu, D. Lillington, M.-Q. Du, D. Syndercombe-Court, A. C. Newland, J. G. Gribben, et al.
Increased proteasomal degradation of Bax is a common feature of poor prognosis chronic lymphocytic leukemia
Blood, March 1, 2008; 111(5): 2790 - 2796.
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BloodHome page
G. Roos, A. Krober, P. Grabowski, D. Kienle, A. Buhler, H. Dohner, R. Rosenquist, and S. Stilgenbauer
Short telomeres are associated with genetic complexity, high-risk genomic aberrations, and short survival in chronic lymphocytic leukemia
Blood, February 15, 2008; 111(4): 2246 - 2252.
[Abstract] [Full Text] [PDF]


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haematolHome page
N. Gachard, A. Salviat, C. Boutet, C. Arnoulet, F. Durrieu, B. Lenormand, S. Lepretre, S. Olschwang, F. Jardin, M. Lafage-Pochitaloff, et al.
Multicenter study of ZAP-70 expression in patients with B-cell chronic lymphocytic leukemia using an optimized flow cytometry method
Haematologica, February 1, 2008; 93(2): 215 - 223.
[Abstract] [Full Text] [PDF]


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BloodHome page
F. Murray, N. Darzentas, A. Hadzidimitriou, G. Tobin, M. Boudjogra, C. Scielzo, N. Laoutaris, K. Karlsson, F. Baran-Marzsak, A. Tsaftaris, et al.
Stereotyped patterns of somatic hypermutation in subsets of patients with chronic lymphocytic leukemia: implications for the role of antigen selection in leukemogenesis
Blood, February 1, 2008; 111(3): 1524 - 1533.
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BloodHome page
C. Saddler, P. Ouillette, L. Kujawski, S. Shangary, M. Talpaz, M. Kaminski, H. Erba, K. Shedden, S. Wang, and S. N. Malek
Comprehensive biomarker and genomic analysis identifies p53 status as the major determinant of response to MDM2 inhibitors in chronic lymphocytic leukemia
Blood, February 1, 2008; 111(3): 1584 - 1593.
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BloodHome page
G. S. Sellick, R. Wade, S. Richards, D. G. Oscier, D. Catovsky, and R. S. Houlston
Scan of 977 nonsynonymous SNPs in CLL4 trial patients for the identification of genetic variants influencing prognosis
Blood, February 1, 2008; 111(3): 1625 - 1633.
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Clin. Cancer Res.Home page
S. Baskar, K. Y. Kwong, T. Hofer, J. M. Levy, M. G. Kennedy, E. Lee, L. M. Staudt, W. H. Wilson, A. Wiestner, and C. Rader
Unique Cell Surface Expression of Receptor Tyrosine Kinase ROR1 in Human B-Cell Chronic Lymphocytic Leukemia
Clin. Cancer Res., January 15, 2008; 14(2): 396 - 404.
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BloodHome page
P. G. Longo, L. Laurenti, S. Gobessi, S. Sica, G. Leone, and D. G. Efremov
The Akt/Mcl-1 pathway plays a prominent role in mediating antiapoptotic signals downstream of the B-cell receptor in chronic lymphocytic leukemia B cells
Blood, January 15, 2008; 111(2): 846 - 855.
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BloodHome page
V. Gattei, P. Bulian, M. I. Del Principe, A. Zucchetto, L. Maurillo, F. Buccisano, R. Bomben, M. Dal-Bo, F. Luciano, F. M. Rossi, et al.
Relevance of CD49d protein expression as overall survival and progressive disease prognosticator in chronic lymphocytic leukemia
Blood, January 15, 2008; 111(2): 865 - 873.
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haematolHome page
A. W. Hauswirth and U. Jager
Impact of cytogenetic and molecular prognostic markers on the clinical management of chronic lymphocytic leukemia
Haematologica, January 1, 2008; 93(1): 14 - 19.
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ASH Education BookHome page
J. G. Gribben
Molecular Profiling in CLL
Hematology, January 1, 2008; 2008(1): 444 - 449.
[Abstract] [Full Text] [PDF]


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Am Soc Clin Oncol Ed BookHome page
T. J. Kipps
Chronic Lymphocytic Leukemia: Prognostic Markers and Revised Criteria for Treatment and Response Assessment
ASCO Educational Book, January 1, 2008; 2008(1): 286 - 290.
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Am Soc Clin Oncol Ed BookHome page
J. G. Gribben
The Role of Stem Cell Transplantation in Chronic Lymphocytic Leukemia
ASCO Educational Book, January 1, 2008; 2008(1): 291 - 296.
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BloodHome page
R. N. Damle, S. Temburni, C. Calissano, S. Yancopoulos, T. Banapour, C. Sison, S. L. Allen, K. R. Rai, and N. Chiorazzi
CD38 expression labels an activated subset within chronic lymphocytic leukemia clones enriched in proliferating B cells
Blood, November 1, 2007; 110(9): 3352 - 3359.
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haematolHome page
S. Willimott, M. Baou, S. Huf, S. Deaglio, and S. D. Wagner
Regulation of CD38 in proliferating chronic lymphocytic leukemia cells stimulated with CD154 and interleukin-4
Haematologica, October 1, 2007; 92(10): 1359 - 1366.
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Clin. Chem.Home page
B. Stamatopoulos, N. Meuleman, B. Haibe-Kains, H. Duvillier, M. Massy, P. Martiat, D. Bron, and L. Lagneaux
Quantification of ZAP70 mRNA in B Cells by Real-Time PCR Is a Powerful Prognostic Factor in Chronic Lymphocytic Leukemia
Clin. Chem., October 1, 2007; 53(10): 1757 - 1766.
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J. Durig, P. Ebeling, F. Grabellus, U. R. Sorg, M. Mollmann, P. Schutt, J. Gothert, L. Sellmann, S. Seeber, M. Flasshove, et al.
A Novel Nonobese Diabetic/Severe Combined Immunodeficient Xenograft Model for Chronic Lymphocytic Leukemia Reflects Important Clinical Characteristics of the Disease
Cancer Res., September 15, 2007; 67(18): 8653 - 8661.
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haematolHome page
S. Stilgenbauer, S. Sander, L. Bullinger, A. Benner, E. Leupolt, D. Winkler, A. Krober, D. Kienle, P. Lichter, and H. Dohner
Clonal evolution in chronic lymphocytic leukemia: acquisition of high-risk genomic aberrations associated with unmutated VH, resistance to therapy, and short survival
Haematologica, September 1, 2007; 92(9): 1242 - 1245.
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J. Mol. Diagn.Home page
L. V. Abruzzo, L. L. Barron, K. Anderson, R. J. Newman, W. G. Wierda, S. O'Brien, A. Ferrajoli, M. Luthra, S. Talwalkar, R. Luthra, et al.
Identification and Validation of Biomarkers of IgVH Mutation Status in Chronic Lymphocytic Leukemia Using Microfluidics Quantitative Real-Time Polymerase Chain Reaction Technology
J. Mol. Diagn., September 1, 2007; 9(4): 546 - 555.
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BioinformaticsHome page
B. A. Gaeta, H. R. Malming, K. J.L. Jackson, M. E. Bain, P. Wilson, and A. M. Collins
iHMMune-align: hidden Markov model-based alignment and identification of germline genes in rearranged immunoglobulin gene sequences
Bioinformatics, July 1, 2007; 23(13): 1580 - 1587.
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J. Clin. Pathol.Home page
E. Sabattini, R. Orduz, C. Campidelli, P. L. Zinzani, V. Callea, S. Zupo, G. Cutrona, F. Morabito, M. Ferrarini, and S. Pileri
B cell chronic lymphocytic leukaemia/small lymphocytic lymphoma: role of ZAP70 determination on bone marrow biopsy specimens
J. Clin. Pathol., June 1, 2007; 60(6): 627 - 632.
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BloodHome page
P. Josefsson, C. H. Geisler, H. Leffers, J. H. Petersen, M. K. Andersen, J. Jurlander, and A. M. Buhl
CLLU1 expression analysis adds prognostic information to risk prediction in chronic lymphocytic leukemia
Blood, June 1, 2007; 109(11): 4973 - 4979.
[Abstract] [Full Text] [PDF]


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BloodHome page
W. G. Wierda, S. O'Brien, X. Wang, S. Faderl, A. Ferrajoli, K.-A. Do, J. Cortes, D. Thomas, G. Garcia-Manero, C. Koller, et al.
Prognostic nomogram and index for overall survival in previously untreated patients with chronic lymphocytic leukemia
Blood, June 1, 2007; 109(11): 4679 - 4685.
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BloodHome page
C. Ian Mockridge, K. N. Potter, I. Wheatley, L. A. Neville, G. Packham, and F. K. Stevenson
Reversible anergy of sIgM-mediated signaling in the two subsets of CLL defined by VH-gene mutational status
Blood, May 15, 2007; 109(10): 4424 - 4431.
[Abstract] [Full Text] [PDF]


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BloodHome page
L. D. Vallat, Y. Park, C. Li, and J. G. Gribben
Temporal genetic program following B-cell receptor cross-linking: altered balance between proliferation and death in healthy and malignant B cells
Blood, May 1, 2007; 109(9): 3989 - 3997.
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G. S. Nowakowski, J. D. Hoyer, T. D. Shanafelt, S. M. Geyer, B. R. LaPlant, T. G. Call, D. F. Jelinek, C. S. Zent, and N. E. Kay
Using Smudge Cells on Routine Blood Smears to Predict Clinical Outcome in Chronic Lymphocytic Leukemia: A Universally Available Prognostic Test
Mayo Clin. Proc., April 1, 2007; 82(4): 449 - 453.
[Abstract] [Full Text] [PDF]


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BloodHome page
R. Bomben, M. Dal Bo, D. Capello, D. Benedetti, D. Marconi, A. Zucchetto, F. Forconi, R. Maffei, E. M. Ghia, L. Laurenti, et al.
Comprehensive characterization of IGHV3-21-expressing B-cell chronic lymphocytic leukemia: an Italian multicenter study
Blood, April 1, 2007; 109(7): 2989 - 2998.
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BloodHome page
G. R. Kolar, D. Mehta, R. Pelayo, and J. D. Capra
A novel human B cell subpopulation representing the initial germinal center population to express AID
Blood, March 15, 2007; 109(6): 2545 - 2552.
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JCOHome page
M. R. Grever, D. M. Lucas, G. W. Dewald, D. S. Neuberg, J. C. Reed, S. Kitada, I. W. Flinn, M. S. Tallman, F. R. Appelbaum, R. A. Larson, et al.
Comprehensive Assessment of Genetic and Molecular Features Predicting Outcome in Patients With Chronic Lymphocytic Leukemia: Results From the US Intergroup Phase III Trial E2997
J. Clin. Oncol., March 1, 2007; 25(7): 799 - 804.
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haematolHome page
E. Ocana, L. Delgado-Perez, A. Campos-Caro, J. Munoz, A. Paz, R. Franco, and J. A. Brieva
The prognostic role of CXCR3 expression by chronic lymphocytic leukemia B cells
Haematologica, March 1, 2007; 92(3): 349 - 356.
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BloodHome page
S. Gobessi, L. Laurenti, P. G. Longo, S. Sica, G. Leone, and D. G. Efremov
ZAP-70 enhances B-cell-receptor signaling despite absent or inefficient tyrosine kinase activation in chronic lymphocytic leukemia and lymphoma B cells
Blood, March 1, 2007; 109(5): 2032 - 2039.
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BloodHome page
A. D. Volkheimer, J. B. Weinberg, B. E. Beasley, J. F. Whitesides, J. P. Gockerman, J. O. Moore, G. Kelsoe, B. K. Goodman, and M. C. Levesque
Progressive immunoglobulin gene mutations in chronic lymphocytic leukemia: evidence for antigen-driven intraclonal diversification
Blood, February 15, 2007; 109(4): 1559 - 1567.
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F. Van Bockstaele, V. Pede, A. Janssens, F. Callewaert, F. Offner, B. Verhasselt, and J. Philippe
Lipoprotein Lipase mRNA Expression in Whole Blood Is a Prognostic Marker in B Cell Chronic Lymphocytic Leukemia
Clin. Chem., February 1, 2007; 53(2): 204 - 212.
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BloodHome page
K. Stamatopoulos, C. Belessi, C. Moreno, M. Boudjograh, G. Guida, T. Smilevska, L. Belhoul, S. Stella, N. Stavroyianni, M. Crespo, et al.
Over 20% of patients with chronic lymphocytic leukemia carry stereotyped receptors: pathogenetic implications and clinical correlations
Blood, January 1, 2007; 109(1): 259 - 270.
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I. Tinhofer, G. Rubenzer, C. Holler, E. Hofstaetter, M. Stoecher, A. Egle, M. Steurer, and R. Greil
Expression levels of CD38 in T cells predict course of disease in male patients with B-chronic lymphocytic leukemia
Blood, November 1, 2006; 108(9): 2950 - 2956.
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BloodHome page
F. Dicker, S. Schnittger, T. Haferlach, W. Kern, and C. Schoch
Immunostimulatory oligonucleotide-induced metaphase cytogenetics detect chromosomal aberrations in 80% of CLL patients: a study of 132 CLL cases with correlation to FISH, IgVH status, and CD38 expression
Blood, November 1, 2006; 108(9): 3152 - 3160.
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JCOHome page
T. D. Shanafelt, T. E. Witzig, S. R. Fink, R. B. Jenkins, S. F. Paternoster, S. A. Smoley, K. J. Stockero, D. M. Nast, H. C. Flynn, R. C. Tschumper, et al.
Prospective Evaluation of Clonal Evolution During Long-Term Follow-Up of Patients With Untreated Early-Stage Chronic Lymphocytic Leukemia
J. Clin. Oncol., October 1, 2006; 24(28): 4634 - 4641.
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Clin. Cancer Res.Home page
U. H. Frey, H. Nuckel, L. Sellmann, D. Siemer, R. Kuppers, J. Durig, U. Duhrsen, and W. Siffert
The GNAS1 T393C Polymorphism Is Associated with Disease Progression and Survival in Chronic Lymphocytic Leukemia.
Clin. Cancer Res., October 1, 2006; 12(19): 5686 - 5692.
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ANN INTERN MEDHome page
T. D. Shanafelt, J. C. Byrd, T. G. Call, C. S. Zent, and N. E. Kay
Narrative review: initial management of newly diagnosed, early-stage chronic lymphocytic leukemia.
Ann Intern Med, September 19, 2006; 145(6): 435 - 447.
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J. F. Fecteau, G. Cote, and S. Neron
A New Memory CD27-IgG+ B Cell Population in Peripheral Blood Expressing VH Genes with Low Frequency of Somatic Mutation
J. Immunol., September 15, 2006; 177(6): 3728 - 3736.
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A. G. Polson, B. Zheng, K. Elkins, W. Chang, C. Du, P. Dowd, L. Yen, C. Tan, J.-A. Hongo, H. Koeppen, et al.
Expression pattern of the human FcRH/IRTA receptors in normal tissue and in B-chronic lymphocytic leukemia
Int. Immunol., September 1, 2006; 18(9): 1363 - 1373.
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