title: Immunogenetic studies of chronic lymphocytic leukemia: revelations and speculations about ontogeny and clinical evolution.
abstract: Over the last decade, immunogenetic analysis of B-cell receptor immunoglobulins (BcR IG) has proved instrumental in dissecting chronic lymphocytic leukemia (CLL) pathogenesis. Initially, it was the finding that the level of somatic hypermutations in rearranged IG heavy-chain genes could define two CLL subtypes associated with a different clinical course that drew attention. As the years ensued, this not only continued to hold strong, but also revealed an unprecedented BcR restriction (aptly coined as "stereotypy"), thus cementing the idea that antigenic elements select the leukemic clones. With all this in mind, in the present review, we focus on the CLL BcR IG, a molecule that clearly lies at the heart of disease pathogenesis, and attempt to distil from past and emerging biologic knowledge the most relevant aspects in the context of the immunogenetics of CLL, while at the same time provoking questions that remain unanswered. We juxtapose CLL with mutated BcR IGs against CLL with unmutated BcR IGs due to their striking clinicobiologic differences; however, when considering ontogeny, common derivation of the two mutational subtypes cannot be excluded. The issue of stereotypy is intertwined throughout and we also raise the subject of isotype-switched CLL, which, despite its rarity, contributes intriguing ontogenetic hints.
authors: Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece. Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece.
authors: Anna
authors: A
authors: Vardi
authors: Division of Molecular Oncology and Department of Onco-Hematology, IRCCS Istituto Scientifico San Raffaele and Fondazione Centro San Raffaele, Milan, Italy.
authors: Andreas
authors: A
authors: Agathangelidis
authors: Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden.
authors: Lesley-Ann
authors: LA
authors: Sutton
authors: Division of Molecular Oncology and Department of Onco-Hematology, IRCCS Istituto Scientifico San Raffaele and Fondazione Centro San Raffaele, Milan, Italy. Università Vita-Salute San Raffaele, Milan, Italy.
authors: Paolo
authors: P
authors: Ghia
authors: Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden.
authors: Richard
authors: R
authors: Rosenquist
authors: Institute of Applied Biosciences, Center for Research and Technology Hellas, Thessaloniki, Greece. Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece. Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Sweden. kostas.stamatopoulos@gmail.com.
authors: Kostas
authors: K
authors: Stamatopoulos
mesh_terms: D000818:Animals; D006801:Humans; D007125:Immunogenetics; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000235:genetics* / Q000276:immunology* / Q000473:pathology