B-cell chronic lymphocytic leukemia (CLL) consists of 2 prognostic entities where cases with mutated immunoglobulin V H genes have better outcome than unmutated cases. V H -mutated CLLs display longer telomeres compared with unmutated cases and telomere length has been indicated to predict outcome, although the prognostic value of telomere length has not been fully established in CLL. We analyzed telomere length, V H gene mutation status, and clinical parameters in a large series of CLL. Telomere length was assessed by quantitative polymerase chain reaction (PCR), giving a very good correlation to telomere length estimated by Southern blotting (P < .001). The prognostic information given by mutation status (n ‫؍‬ 282) and telomere length (n ‫؍‬ 246) was significant (P < .001, respectively). Telomere length was a prognostic factor for stage A (P ‫؍‬ .021) and stage B/C (P ‫؍‬ .018) patients, whereas mutation status predicted outcome only in stage A patients (P < .001). Furthermore, mutated CLLs were subdivided by telomere length into 2 groups with different prognoses (P ‫؍‬ .003), a subdivision not seen for unmutated cases (P ‫؍‬ .232). Interestingly, the V H -mutated group with short telomeres had an overall survival close to that of the unmutated cases. Thus, by combining V H mutation status and telomere length, an improved subclassification of CLL was achieved identifying previously unrecognized patient groups with different outcomes. IntroductionThe end structures of the chromosomes, the telomeres, are composed of a repetitive DNA sequence, (TTAGGG) n , and specific proteins bound to the DNA. 1,2 The telomeres protect the chromosomes from degradation, prevent end-to-end fusions, and are crucial for control of replicative senescence. In humans, the telomeres have an average length of 5 kilobases (kb) to 15 kb and in normal somatic cells the telomeric DNA shortens with 100 base pair (bp) to 200 bp every cell division due to the end-replication problem. [3][4][5] The erosion of the telomeres can be counteracted by telomerase, an enzyme that adds TTAGGG repeats to the chromosomal ends. 6 Telomere maintenance, usually executed by telomerase, is a prerequisite for an extended or infinite cellular lifespan, and studies of telomere dynamics have been in focus ever since it was shown that telomerase activity is present in almost 90% of all malignant tumors. [7][8][9] The nearly exclusive presence of telomerase in tumor cells has made the enzyme a theoretically attractive target for cancer therapy. In contrast, telomerase is restricted to a few normal cell types in humans, including germ cells, stem cells, activated lymphocytes, and epithelial cells with high reproductive demand. [10][11][12][13][14] Additionally, during the germinal center (GC) reaction in lymph nodes a high level of telomerase activity is expressed in the GC B cells accompanied by a unique telomere lengthening process not observed in other cells in vivo. [15][16][17] Telomere length reduction has been found with increasing age and was recently impli...

The G(-248)A polymorphism in the promoter region of the Bax gene was recently associated with low Bax expression, more advanced stage, treatment resistance and short overall survival in B-cell chronic lymphocytic leukemia (CLL), the latter particularly in treated patients. To investigate this further, we analyzed 463 CLL patients regarding the presence or absence of the G(-248)A polymorphism and correlated with overall survival, treatment status and known prognostic factors, for example, Binet stage, V H mutation status and genomic aberrations. In this material, similar allele and genotype frequencies of the Bax polymorphism were demonstrated in CLL patients and controls (n ¼ 207), where 19 and 21% carried this polymorphism, respectively, and no skewed distribution of the polymorphism was evident between different Binet stages and V H mutated and unmutated CLLs. Furthermore, no difference in overall survival was shown between patients displaying the G(-248)A polymorphism or not (median survival 85 and 102 months, respectively, P ¼ 0.21), and the polymorphism did not influence outcome specifically in treated CLL. Neither did the polymorphism affect outcome in prognostic subsets defined by V H mutation status or genomic aberrations. In conclusion, the pathogenic role and clinical impact of the Bax polymorphism is limited in CLL.

In vitro, gefitinib has significant cytotoxic activity in AML by inducing apoptosis through non-EGFR dependent pathways.