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Blood, 1 July 2008, Vol. 112, No. 1, pp. 179-187.
Prepublished online as a Blood First Edition Paper on February 26, 2008; DOI 10.1182/blood-2008-01-131359.


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Submitted January 2, 2008
Accepted February 3, 2008

FCRL2 expression predicts IGHV mutation status and clinical progression in chronic lymphocytic leukemia

Fu Jun Li, Shouluan Ding, Jicun Pan, Mikhail A Shakhmatov, Elena Kashentseva, Jiongru Wu, Yufeng Li, Seng-jaw Soong, Nicholas Chiorazzi, and Randall S. Davis*

Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, United States
Laboratory of Experimental Immunology, The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY, United States
Division of Microbiology, University of Alabama at Birmingham, Birmingham, AL, United States

* Corresponding author; email: rsdavis{at}uab.edu.

CD38 and ZAP-70 are both useful prognostic markers for B cell chronic lymphocytic leukemia (CLL), but are variably discordant with IGHV mutation status. Five human Fc receptor-like (FCRL1-5) molecules have tyrosine-based immunoregulatory potential and are expressed by B lineage subpopulations. To determine their prognostic potential in CLL, FCRL expression was compared with IGHV mutation status, CD38 and ZAP-70 expression, and clinical features from 107 cases. FCRL1-3 and FCRL5 were found at markedly higher levels on CLL cells bearing mutated IGHV genes than unmutated CLL cells or CD19+ polyclonal B lymphocytes. Univariate comparisons found that similar to CD38 and ZAP-70, FCRL expression was strongly associated with IGHV mutation status; however, only FCRL2 maintained independent predictive value by multivariate logistic analysis. Strikingly, FCRL2 demonstrated 94.4% concordance with IGHV mutation compared to 76.6% for CD38 and 80.4% for ZAP-70. Compared to other indicators, FCRL2 was also superior at predicting the time to first therapy; the median treatment-free interval was 15.5 years for patients with high FCRL2 expression compared to 3.75 years for FCRL2 low patients. Our studies indicate that FCRL2 has robust predictive value for determining IGHV gene mutation status and clinical progression and thus may further improve prognostic definition in CLL.


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