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  • American Society of Hematology  (3)
  • 1
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 1196-1196
    Abstract: Introduction: Although expression of β1 integrins was analyzed in B-cell chronic lymphocytic leukemia (B-CLL), little is known about the clinical behaviour and the phenotyic profile of B-CLLs with different patterns of β1 integrin expression. Methods: Expression of β1 integrins (α1-α6) was investigated by flow cytometry along with other 30 surface molecules (B-cell markers, cell-adhesion-molecules, activation inducers, complement activity regulators) in 155 B-CLLs, 106 characterized for clinical stage (Rai’s stages), 121 for IgVH mutations, 79 for ZAP-70 expression and 109 with survival data. Results: In agreement with previous studies, also in our B-CLL series CD49c, CD49d and, to a lesser extent, CD49e resulted the most expressed β1 integrins, with mean expression values, evaluated as % of positive cells, of 59%, 36% and 26% (range 1-100%), respectively. Since expression of CD49c and CD49d have been recently identified by us as part of the immunophenotypic signatures of B-CLLs with different prognosis (J Cell Physiol204, 113, 2005), the present study was designed to define: 1) the real prognostic impact and the optimal cutoffs for CD49c and CD49d splitting patients into two groups with different survivals; 2) the immunophenotypic and molecular features of B-CLL subsets expressing different levels of CD49c and CD49d. 1) By applying the maximally selected log-rank statistics, we identified cutoff values of 40% and 30% of positive cells for CD49c and CD49d, respectively; therefore, B-CLL cases were divided in CD49chigh or CD49clow and CD49dhigh or CD49dlow if the expression of the molecules was above or below their respective cutoffs. The CD49chigh B-CLL subset (n=78) displayed longer survival as compared to CD49clow cases (n=31; p=2.0x10-2, log-rank test); conversely, CD49dhigh B-CLLs (n=46) had shorter survivals, as compared to the CD49dlow subset (n=62; p=1.2x10-3). 2) Supervised analyses were performed by comparing the expression of a wide panel of surface antigens in CD49chigh vs. CD49clow and CD49dhigh vs. CD49dlow B-CLLs. In addition, B-CLL subgroups, as identified by CD49c and CD49d expression, were compared for IgVH mutations (2% cutoff), ZAP-70 expression (30% cutoff) and Rai’s stages distribution (stages 0-I vs. II-IV). According to these analyses, CD62L, CD22, CD55, CD29, CD11c, CD54 and CD40 were the molecules significantly over-expressed in good prognosis CD49chigh B-CLLs, as compared to CD49clow cases (p & lt;0.05; t-test); consistently, CD49chigh vs. CD49clow B-CLLs had mutated:unmutated (M:UM) ratios of 2.2 vs. 0.6 (p=9.2x10-3; Chi-square Test). Bad prognosis CD49dhigh B-CLLs, as compared to CD49dlow cases, over-expressed CD38, CD29, CD49e, CD79b and displayed a lower expression of CD11c (p & lt;0.05). In the same subsets, M:UM ratios were 0.6 (CD49dhigh) or 3.4 (CD49dlow; p=4.2x10-5; Chi-square Test); finally, the frequency of both ZAP-70+ cases and cases with advanced Rai’s stages (II-IV) was significantly higher (p=5.6x10-4 and 2.9x10-2, respectively) in CD49dhigh B-CLLs. Conclusion: CD49c and CD49d identify B-CLL subsets with peculiar clinico-biological features, allegedly originating from different normal B cell counterparts; under a clinical standpoint, CD49c and CD49d may be employed as additional prognosticators for B-CLLs.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 2
    In: Blood, American Society of Hematology, Vol. 104, No. 11 ( 2004-11-16), p. 2797-2797
    Abstract: Studies of gene expression profiling of B-CLL cells revealed a phenotype related to experienced B cells, although only a subset of B-CLLs has IgVH mutations. With the aim to identify the immunophenotypic profile associated with a different prognosis, we investigated by flow cytometry the expression of 36 surface molecules (cell-adhesion molecules, integrins, complement activity regulators, myeloid, T and B markers) in 125 B-CLLs, all characterized for IgVH mutations and survival. To recognize the surface molecules with survival predictive power, univariate Cox proportional-hazards analysis was applied to antigen expression values with overall survival as dependent variable. Once identified the antigens whose expression correlated with a z score of ±2.5 (P & lt;0.005) or greater, the maximally selected log-rank statistics were applied to define the optimal cut-off values yielding the best separation of two subgroups with different survival. According to this approach, the following eight antigens were selected (cut-off values in parenthesis): CD55 (30%), CD62L (30%), CD49c (40%), CD11c (20%), CD54 (50%), CD25 (15%), CD79b (65%), CD38 (30%). The first six antigens had negative z score and therefore were identified as favorable prognosticators, while CD79b and CD38 had positive z score, hence were associated with shorter overall survival (negative prognosticators). To build-up a scoring system, we assigned score “1” to each positive prognosticator when its expression was above the designated cut-off (score “0” if below), and score “0” to each negative prognosticator when its expression was above the cut-off (score “1” if below). A total score ranging from 0 to 8 points was therefore obtained in 102/125 cases in which the expression of all the eight markers was available. Three risk groups were identified: i) high-risk (29 cases), score 0–3; ii) intermediate-risk (38 cases), score 4–6; iii) low-risk (35 cases), score 7–8. These three groups differed greatly for survival probabilities (p=5x10–13 by the log-rank test). All patients belonging to the low-risk group were alive throughout the follow-up duration, whereas mean survivals for intermediate- and high-risk groups were 173 months (p=0.032) and 61 months (p=2.0x10–9), respectively. Several relationship between risk groups and other variables was studied: i) patients included in high- and intermediate-risk groups had the same male to female (M:F) ratio (1.4), while the M:F ratio of patients included in low-risk group (group 3) was lower (0.7); ii) Rai’s stage distribution was comparable in the three groups, with the exception of stage “0”, which was significantly less frequent in the high-risk group (p=0.04); iii) if % IgVH mutations (2% cut-off) was checked, mutated to unmutated (M:UM) ratios were 4.8, 2.6 and 0.8 in low-, intermediate- and high-risk groups, respectively (p=0.006); iv) as compared to high-risk group, low- and intermediate-risk groups were characterized by a higher number of B-CLL cases with a IgVH mutational status consistent with antigen-driven selection (20/24 and 17/26 vs. 7/13). In conclusion, the present study introduces a novel predictive tool based on the expression of eight surface molecules, easily investigable, which can stratifies populations of B-CLL patients in three distinct risk categories.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2004
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
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  • 3
    In: Blood, American Society of Hematology, Vol. 106, No. 11 ( 2005-11-16), p. 2106-2106
    Abstract: Quantitative evaluation of IgVH genes mutations is widely considered a reliable prognosticator in B-CLL. Conversely, conflicting results have been reported regarding the prognostic impact of IgVH gene mutations when evidence of Ag-driven selection is investigated. To address this issue, the mutational status of IgVH genes was analysed in peripheral blood samples of 147 B-CLL patients, all with survivals, by a strategy of RT-PCR and cloning; B-CLL specific IgVH transcripts were analysed for both % mutation and Ag-driven selection by applying a multinomial statistical model evaluating the excess/scarcity of replacement/silent mutations in FR/CDR sequences of IgVH genes. Maximally selected log-rank statistics, applied for IgVH gene % mutations, estimated the most appropriate cutoffs capable to separate B-CLL patients into two subgroups with different survival; this approach identified an absolute peak at 0.2% IgVH mutations and two relative peaks at about 2% and 4% IgVH mutations. We therefore tested the impact of Ag-driven selection on B-CLL patient survival in the context of the cutoffs of 0.2, 2 and 4% IgVH mutations. For each cutoff, B-CLL cases were identified as mutated (M) or unmutated (UM) if the % IgVH mutations were above or below the chosen cutoff, respectively; M B-CLLs with evidence of Ag selection were named significantly mutated (sM), while cases lacking such an evidence were reported as not-sM (nsM). 1) 0.2% IgVH cutoff - The 133 B-CLLs with 〉 0.2% mutations had longer survivals as compared to 14 cases with 〈 0.2% mutations (p=2.6x10-5); regarding the prognostic impact of Ag selection within the 133 M B-CLLs, 78 sM B-CLL patients had longer survivals than the 55 nsM B-CLLs (p=2.7x10-2). This latter group maintained a better prognosis as compared to UM B-CLLs (p=8.8x10-3); 2) 2% IgVH cutoff - Using the standard cutoff, 99 M B-CLL cases, displaying 〉 2% mutations, had longer survivals as compared to 48 UM cases with 〈 2% mutations (p=1.4x10-4); again, within the M B-CLL group, 65 sM B-CLL patients had longer survivals than 34 nsM B-CLLs (p=1.4x10-2); nsM and UM B-CLL patients had similar survivals (p = 0.1); 3) 4% IgVH cutoff - According to this cutoff, 75 B-CLLs were M B-CLLs, while 72 cases were UM B-CLLs. Only percent of IgVH mutations split B-CLLs into two subgroups with different survivals (p=4.9x10-4); sM and nsM B-CLLs with 〉 4% mutations had similar survivals; 4) sM vs. nsM (all cases) - In the absence of any cutoff, the 78 patients with sM B-CLLs had longer survival as compared to the 69 affected by nsM B-CLLs (p=9.6x10-4). By taking together this data, it appears that the use of % IgVH mutations remains the gold-standard for the definition of prognosis in B-CLL; however, at least when the canonical 2% cutoff is applied, a certain caution should be used by predicting patient survival in the absence of information regarding the affinity maturation of B-CLL clones. The expression by B-CLL cells of IgVH segments with evidence of affinity maturation seems to lose its positive prognostic impact when a cutoff is set at 4% IgVH mutations. In addition to its obvious clinical impact, these observations provide a putative explanation of the apparent discrepancies found in the scientific literature about this matter.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
    RVK:
    RVK:
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2005
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
    Location Call Number Limitation Availability
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