title: Perturbation of the normal immune system in patients with CLL.
abstract: Immune dysregulation is a cardinal feature of chronic lymphocytic leukemia (CLL) from its early stage and worsens during clinical observation, even in absence of disease progression. Although the mechanisms remain unclear, new insights are emerging into the complex relationship between the CLL clone and its immune environment. T cells are increased in early-stage disease and show progressive accumulation and exhaustion. The mechanisms that drive this expansion may include auto-antigens involved in the original clonal expansion. In addition, chronic viral infections such as cytomegalovirus generate huge virus-specific immune responses, which are further expanded in CLL. Attention is now focused largely on the direct immunosuppressive properties of the tumor. Remarkably, CLL clones often have features of the recently described regulatory B cells producing immunosuppressive IL-10. Better knowledge of the regulatory properties intrinsic to CLL cells may soon become more important with the switch from chemotherapy-based treatments, which trade control of CLL with further impairment of immune function, to the new agents targeting CLL B-cell receptor-associated signaling. Treatment with these new agents is associated with evidence of immune recovery and reduced infectious complications. As such, they offer the prospect of immunologic rehabilitation and a platform from which to ultimately replace chemotherapy.
authors.affiliation: Haematology Oncology Group, Cancer Sciences Unit, Cancer Research UK Centre and National Institute for Health Research Experimental Cancer Medicine Centre, University of Southampton, Faculty of Medicine, Southampton, United Kingdom; Haematology Department, University Hospital Southampton National Health Service Trust, Southampton, United Kingdom; and.
authors.forename: Francesco
authors.identifier: http://orcid.org/0000-0002-2211-1831
authors.initials: F
authors.lastname: Forconi
authors.affiliation: School of Cancer Sciences, University of Birmingham & University Medical School, Birmingham, United Kingdom.
authors.forename: Paul
authors.identifier: http://orcid.org/0000-0002-6895-1967
authors.initials: P
authors.lastname: Moss
mesh_terms: D056704:Adaptive Immunity; D000361:Agammaglobulinemia / Q000209:etiology / Q000276:immunology; D001402:B-Lymphocytes / Q000276:immunology; D006801:Humans; D007108:Immune Tolerance; D007113:Immunity, Innate; D007239:Infections / Q000453:epidemiology / Q000209:etiology / Q000276:immunology; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000276:immunology* / Q000628:therapy; D013601:T-Lymphocytes / Q000276:immunology; D047368:Tumor Burden / Q000276:immunology; D019139:Tumor Escape