Immune thrombocytopenia in patients with chronic lymphocytic leukemia is associated with stereotyped B-cell receptors.

Department of Hematology, Ospedale San Bortolo, Vicenza, Milano, Italy.

Clinical cancer research : an official journal of the American Association for Cancer Research 2012 Apr 1

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To assess biologic features related to the development of immune thrombocytopenia (ITP) in patients with chronic lymphocytic leukemia (CLL). We retrospectively analyzed 463 patients with CLL with available immunoglobulin heavy-chain variable (IGHV) gene status and B-cell receptor (BCR) configuration [heavy-chain complementary-determining region 3 (HCDR3)], of whom thirty-six developed ITP, according to previously defined criteria. Most of them had available cytogenetic analysis. We observed a significant association between ITP occurrence and IGHV unmutated gene status (P < 0.0001), unfavorable cytogenetic lesions (P = 0.005), and stereotyped HCDR3 (P = 0.006). The more frequent stereotyped HCDR3 subsets were #1 (IGHV1-5-7/IGHD6-19/IGHJ4; 16 of 16 unmutated) and #7 (IGHV1-69 or IGHV3-30/IGHD3-3/IGHJ6; 13 of 13 unmutated), both being significantly more represented among patients developing ITP (P = 0.003 and P = 0.001, respectively). Moreover, restricting the analysis to unmutated patients, subset #7 confirmed its independent significant association with the occurrence of ITP (P = 0.013). Both unmutated IGHV mutational status, del(11)(q23) and stereotyped BCR were significantly associated with shorter time to ITP development (P < 0.0001, P = 0.02, and P = 0.005, respectively) than other patients. Our data suggest that patients with CLL and peculiar BCR conformations are at higher risk of developing secondary ITP and that stereotyped BCR may be involved in the pathogenesis of this complication. ©2012 AACR.

Citation

Carlo Visco, Francesco Maura, Giacomo Tuana, Luca Agnelli, Marta Lionetti, Sonia Fabris, Elisabetta Novella, Ilaria Giaretta, Gianluigi Reda, Wilma Barcellini, Luca Baldini, Antonino Neri, Francesco Rodeghiero, Agostino Cortelezzi. Immune thrombocytopenia in patients with chronic lymphocytic leukemia is associated with stereotyped B-cell receptors. Clinical cancer research : an official journal of the American Association for Cancer Research. 2012 Apr 1;18(7):1870-8