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Key Points CLL patients harboring mutated IGHV genes but neither 11q or 17p deletion experience durable remission after frontline FCR.

A genetic variant of ARLTS1 predisposes patients to familial cancer.

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We analysed the incidence of graft failure, graft-versus-host disease (GVHD) and relapse of leukaemia in 208 patients undergoing allogeneic bone marrow transplantation (BMT) for chronic myeloid leukaemia in chronic phase in eight transplant centres in Europe and the United States. 106 patients received unmanipulated donor bone marrow (Group 1) and 102 patients received marrow depleted of T-cells by incubation with the monoclonal antibodies Campath-1 or CT-2 and complement (Group 2). The incidence of graft failure was higher and of GVHD was lower in Group 2 than in Group 1. Relapse of leukaemia occurred more frequently in patients in Group 2 than in Group 1 (17 v. 2, P less than 0.001). Multivariate analysis showed that the following factors were associated with an increased risk of relapse: the use of T-cell depletion, the absence of GVHD and a high platelet count at the time of admission for transplant. The findings support the concept that a graft-versus-leukaemia effect mediated by T-lymphocytes is important for cure of leukaemia after BMT.

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Key Points The coding genome of fludarabine-refractory CLL patients is characterized by 16 mutations/case and 4 copy number aberrations per case on average. Fludarabine-refractory CLL cases are enriched in FAT1 mutations occurring in 10% of patients, suggesting a role in the refractoriness event.

Chronic lymphocytic leukemia (CLL) and other B-cell lymphoproliferative disorders display familial aggregation. To identify a susceptibility gene for CLL, we assembled families from the major European (ICLLC) and American (GEC) consortia to conduct a genome-wide linkage analysis of 101 new CLL pedigrees using a high-density single nucleotide polymorphism (SNP) array and combined the results with data from our previously reported analysis of 105 families. Here, we report on the combined analysis of the 206 families. Multipoint linkage analyses were undertaken using both nonparametric (model-free) and parametric (modelbased) methods. After the removal of high linkage disequilibrium SNPs, we obtained a maximum nonparametric linkage (NPL) score of 3.02 (P ‫؍‬ .001) on chromosome 2q21.2. The same genomic position also yielded the highest multipoint heterogeneity LOD (HLOD) score under a common recessive model of disease susceptibility (HLOD ‫؍‬ 3.11; P ‫؍‬ 7.7 ؋ 10 ؊5 ), which was significant at the genome-wide level. In addition, 2 other chromosomal positions, 6p22.1 (corresponding to the major histocompatibility locus) and 18q21.1, displayed HLOD scores higher than 2.1 (P < The striking multiple-case families reported in the literature provide substantive evidence for an inherited predisposition to CLL 2-4 and suggest the existence of susceptibility alleles with pleiotropic effects. 2,10 Case-control and cohort studies that have systematically estimated the familial risk of CLL and other LPDs have shown that most B-cell LPDs display site-specific elevated familial risks, 5-9 but particularly CLL, where risks are increased 3-to 7-fold in first-degree relatives of cases. Furthermore, such studies have demonstrated that familial associations exist between the different types of B-cell LPDs with risks of NHL and HL showing 2-fold increases in relatives of CLL cases..These observations provide a strong rationale for searching for predisposition genes for CLL through linkage searches of multiplecase families. Two genome-wide linkage scans have been conducted to date. The first reported by Goldin et al 11 in 2003 used 359 microsatellite markers to genotype 18 CLL families. In 2005, a second genome-wide scan of 105 families segregating CLL with or without additional B-cell LPD cases was conducted using the Affymetrix Mapping 10Kv131 array, which contained approximately 11 500 single nucleotide polymorphisms (SNPs). 12 In both studies, analyses provided evidence for susceptibility at a number of loci, but none achieved statistical significance, suggesting that a much larger familial sample was required to identify CLL predisposition loci.To address this, we have undertaken a further genome-wide linkage scan of an additional 101 families ascertained through the International CLL Consortium (ICLLC) and the Genetic Epidemiology of CLL (GEC) consortia. This search was conducted using high-density SNP arrays, thereby allowing us to pool findings with data generated from our previous scan of 105 families and in so An Inside Blood...