title: Similar humoral immunity parameters in chronic lymphocytic leukemia patients independent of VH gene mutation status.
abstract: Chronic lymphocytic leukemia (CLL) is a clonal B-cell disorder, which has recently been divided into 2 subtypes based on the somatic hypermutation status of the immunoglobulin heavy chain (IgVH) genes. In patients with unmutated tumor cells the survival time is approximately half of that in mutated cases, but the reason for this difference is poorly understood. Since infections are the major cause of mortality in CLL, we investigated the effect of the mutation status on host immunity and proneness to infections in patients with CLL. As expected, the disease progression seemed to be faster and the disease more advanced (Binet B and C) among unmutated patients than in the mutated ones. Surprisingly, no differences in humoral immunity [immunoglobulin G (IgG), IgM, IgA, IgG subclasses, anti-ABO blood group antibodies and mannan-binding lectin (MBL)] or immune responses (Haemophilus influenzae serotype b conjugate vaccination) were detected between these 2 patient groups. Furthermore, UM-patients were not more prone to infections compared to M-patients, and therapy had no impact on the incidence and pattern of infections in either of the patient groups. The current findings within this patient cohort reveal that the worse outcome in the unmutated subgroup is not caused by more severe defects in immunity and increased susceptibility to infections when compared with the hypermutated group. It is thus conceivable that active immunization procedures such as vaccination can successfully be applied on patients with unmutated IgVH gene and advanced disease stage.
authors.affiliation: Department of Internal Medicine, Tampere University Hospital, Finland. marjatta.sinsalo@pshp.fi
authors.forename: Marjatta
authors.initials: M
authors.lastname: Sinisalo
authors.forename: Janne
authors.initials: J
authors.lastname: Aittoniemi
authors.forename: Tomi
authors.initials: T
authors.lastname: Koski
authors.forename: Gerard
authors.initials: G
authors.lastname: Tobin
authors.forename: Ulf
authors.initials: U
authors.lastname: Thunberg
authors.forename: Christer
authors.initials: C
authors.lastname: Sundström
authors.forename: Richard
authors.initials: R
authors.lastname: Rosenquist
authors.forename: Helena
authors.initials: H
authors.lastname: Käyhty
authors.forename: Juhani
authors.initials: J
authors.lastname: Vilpo
mesh_terms: D000368:Aged; D000917:Antibody Formation / Q000276:immunology*; D005260:Female; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics* / Q000276:immunology*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000235:genetics / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*; D027041:Somatic Hypermutation, Immunoglobulin
chemical_list: D007143:Immunoglobulin Heavy Chains