- Blood. 1999 Sep
15;94(6):1840-7.
Comment in: Blood. 1999 Sep 15;94(6):1837-9. Blood. 2001 Mar
15;97(6):1892-4. Blood. 2002 Oct 15;100(8):3052-3.
Ig V gene mutation status and CD38 expression
as novel prognostic indicators in chronic lymphocytic leukemia.
Damle RN, Wasil T, Fais F, Ghiotto F, Valetto A, Allen SL,
Buchbinder A, Budman D, Dittmar K, Kolitz J, Lichtman SM,
Schulman P, Vinciguerra VP, Rai KR, Ferrarini M, Chiorazzi N.
Department of Medicine, North Shore University Hospital,
Manhasset, NY, USA.
Cellular immunophenotypic studies were performed on a cohort of
randomly selected IgM(+) B-chronic lymphocytic leukemia (B-CLL)
cases for which Ig V(H) and V(L) gene sequences were available.
The cases were categorized based on V gene mutation status and
CD38 expression and analyzed for treatment history and survival.
The B-CLL cases could be divided into 2 groups. Those patients
with unmutated V genes displayed higher percentages of CD38(+)
B-CLL cells (>/=30%) than those with mutated V genes that had
lower percentages of CD38(+) cells (<30%). Patients in both the
unmutated and the >/=30% CD38(+) groups responded poorly to
continuous multiregimen chemotherapy (including fludarabine) and
had shorter survival. In contrast, the mutated and the <30%
CD38(+) groups required minimal or no chemotherapy and had
prolonged survival. These observations were true also for those
patients who stratified to the Rai intermediate risk category.
In the mutated and the <30% CD38(+) groups, males and females
were virtually equally distributed, whereas in the unmutated and
the >/=30% CD38(+) groups, a marked male predominance was found.
Thus, Ig V gene mutation status and the percentages of CD38(+)
B-CLL cells appear to be accurate predictors of clinical outcome
in B-CLL patients. These parameters, especially CD38 expression
that can be analyzed conveniently in most clinical laboratories,
should be valuable adjuncts to the present staging systems for
predicting the clinical course in individual B-CLL cases. Future
evaluations of new therapeutic strategies and drugs should take
into account the different natural histories of patients
categorized in these manners.
PMID: 10477712 [PubMed - indexed for MEDLINE]
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