Anaplastic large-cell lymphoma (ALCL) of T-or nullcell lineage, as defined in the revised European-American lymphoma classification, includes a subset of tumors that carry the t(2;5)(p23;q35) resulting in overexpression of anaplastic lymphoma kinase (ALK). Patients with ALK؉ ALCL are reported to have a better prognosis than patients with ALK؊ ALCL. Because the mechanisms for this survival difference are unknown, we investigated the hypothesis that apoptotic pathways may be involved. We therefore assessed expression levels of the anti-apoptotic proteins BCL-2 and BCL-XL and the pro-apoptotic proteins BAX and BCL-XS in T/nullcell ALCL using immunohistochemical methods and correlated the findings with ALK expression and apoptotic rate (AR), the latter assessed by a modified Tdtmediated dUTP nick-end labeling assay. ALK was de- Anaplastic large-cell lymphoma (ALCL) of T-or null-cell lineage, as defined in the revised European-American lymphoma classification, includes a subset of tumors that carry the t(2;5)(p23;q35). 1,2 The t(2;5) disrupts the nucleophosmin (NPM) gene at 5q35 and the anaplastic lymphoma kinase (ALK) gene at 2p23, generating a novel NPM-ALK gene consisting of the N-terminal portion of NPM fused to the cytoplasmic catalytic domain of ALK. 3,4 The t(2;5), its chimeric transcripts, and resulting overexpression of ALK protein have been detected in a variable proportion of ALCL, ranging from 12 to 80% in different series. [5][6][7][8][9][10] Variant translocations involving 2p23 also can cause overexpression of ALK. 11-14 Several studies have reported that patients with ALKϩ ALCL have better overall survival than patients with ALKϪ ALCL. [15][16][17] However, the underlying biological mechanisms for this survival difference are unknown.A number of proteins are involved in apoptosis, of which the BCL-2 protein family is best known. BCL-2, first identified by its involvement in the t(14;18) (q32;q21), 18,19 is a major negative regulator of apoptosis. The t(14;18) in follicular lymphoma results in BCL-2 overexpression, and represents the first example of oncogenesis mediated by decreased cell death. 20,21 A number of proteins have since been identified that share homology with conserved regions of BCL-2, the BCL-2 homology (BH) domains, and these proteins have either pro-apoptotic or anti-apoptotic activity in mammalian cells. 22 BAX, a 21-kd protein with significant homology clustered in the BH1 and BH2 regions, was the first of these proteins identified and is an important cell death agonist. 23 BCL-X, another gene homologous with BCL-2, gives rise to two alternatively spliced forms with opposite functions, long (BCL-XL) and short (BCL-XS). BCL-XL, like BCL-2, inhibits apoptosis, whereas BCL-XS is a cell death promoter. 24 -26 Many other BCL-2 family members have been described. 22 Pro-apoptotic and anti-apoptotic members of the BCL-2 family are capable of forming homodimers or heterodimers and their relative ratio acts as a rheostat for susceptibility to programmed cell death. 22,27 Supported in part b...