title: Clinical utility of molecular and flow cytometric markers in chronic lymphocytic leukaemia.
abstract: BACKGROUND
  Chronic lymphocytic leukaemia (CLL) is a clinically heterogeneous disease. While immunoglobulin variable region heavy chain (IgVH) mutational status remains the 'gold standard' in molecular prognostication, a range of additional markers is increasingly being used in clinical trials. As awareness of trial data increases, requests to determine these prognostic markers for new CLL patients are becoming more prevalent in Australia.
  
  
  OBJECTIVE
  To explore the clinical utility of currently available prognostic markers for CLL in an Australian cohort.
  
  
  METHODS
  IgVH mutational status and gene usage was determined and compared with other reported immunophenotypic markers, cytogenetics and clinical outcome as defined by treatment-free survival (TFS), lymphocyte doubling time and clinical stage in a cohort of 65 CLL patients.
  
  
  RESULTS
  An unmutated IgVH gene, high expression of CD38, ZAP-70, CD25, CD49d, CD54 or low expression of CD49c was associated with shorter TFS indicating an adverse clinical prognosis in our cohort. High expression of each of CD38, ZAP-70, CD49d and CD54 was significantly associated with an unmutated IgVH gene; however, associations were not absolute. IgVH and CD25 expression retained their significance in multivariate analysis. Concordant CD25(high) /IgVH unmutated CLL patients had the shortest median TFS interval (40 months) in our cohort.
  
  
  CONCLUSIONS
  Molecular and immunophenotypic markers remain useful as adjuncts to clinical prognostication; however, as single parameters they are unable to dictate the timing of therapeutic intervention. The combined use of CD25 and IgVH mutational status may be clinically relevant to CLL prognostication while also providing insight into the biological pathways involved in disease progression.
authors.affiliation: Department of Haematology and Genetic Pathology, Flinders Medical Centre School of Biological Sciences, Flinders University, Adelaide, South Australia, Australia.
authors.forename: M L
authors.initials: ML
authors.lastname: Sulda
authors.forename: B J
authors.initials: BJ
authors.lastname: Kuss
authors.forename: R K
authors.initials: RK
authors.lastname: Hall
authors.forename: S
authors.initials: S
authors.lastname: Bailey
authors.forename: P J
authors.initials: PJ
authors.lastname: Macardle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005434:Flow Cytometry / Q000379:methods*; D006801:Humans; D007135:Immunoglobulin Variable Region / Q000097:blood / Q000235:genetics; D053645:Interleukin-2 Receptor alpha Subunit / Q000097:blood / Q000235:genetics; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000502:physiology
chemical_list: D015415:Biomarkers; C508017:IL2RA protein, human; D007135:Immunoglobulin Variable Region; D053645:Interleukin-2 Receptor alpha Subunit