Key Points• Differentiation of CLL cells in response to IL-21 and cytosine guanine dinucleotide-enriched oligo-deoxynucleotides (CpG-ODN) is variable and linked to PRDM1 induction.• The failure of CLL cells to express or induce PRDM1 correlates with anergy.Despite antigen engagement and intact B-cell-receptor (BCR) signaling, chronic lymphocytic leukemia (CLL) cells fail to undergo terminal differentiation. We hypothesized that such failure may be due to anergy, as CLL cells exhibit variable levels of nonresponsiveness to surface IgM stimulation that is reversible in vitro. Moreover, anergy is associated with reduced differentiation capacity in normal B cells. We investigated responses of CLL cells to two potent differentiation-promoting agents, IL-21 and cytosine guanine dinucleotide-enriched oligo-deoxynucleotides. The induction of PR domaincontaining protein 1 (PRDM1; also known as Blimp-1), a critical regulator of plasmacytic differentiation, by these agents was closely correlated but varied between individual cases, despite functionally intact IL-21 receptor-and Toll-like receptor 9-mediated signal transducer and activator of transcription 3, and nuclear factor-kB pathways. PRDM1 induction was inversely correlated with the extent of anergy as measured by the ability to mobilize intracellular Ca 21 following BCR crosslinking. PRDM1 responsiveness was associated with other markers of differentiation and proliferation but not with differences in apoptosis. The ability to induce PRDM1 did correlate with differential transcriptional and epigenetic regulation of the PRDM1 gene. These studies extend our understanding of CLL pathobiology, demonstrating that reduced differentiation capacity may be a consequence of anergy. Epigenetic drugs may offer possibilities to reactivate PRDM1 expression as part of novel differentiation therapy approaches. (Blood. 2014;123(21):3277-3285)
IntroductionChronic lymphocytic leukemia (CLL) is a malignancy of B lymphocytes that retain dependency on extracellular stimuli for their survival and behavior. Two major CLL subsets have been identified which arise at distinct stages of B-cell differentiation and are characterized by varying levels of somatic hypermutation of immunoglobulin (Ig) V-genes.1 Importantly, these subsets exhibit very different clinical behavior. CLL with unmutated V-genes (U-CLL) appears to develop from naive B cells of the natural antibody repertoire with specificity for common pathogens and has a significantly worse prognosis compared with CLL with mutated V-genes (M-CLL). [2][3][4][5] Further support for a role of antigen stimulation in CLL is provided by the presence of biased V-gene usage in both subsets and the presence of conserved sequence motifs within the complementarity determining region 3s of CLL-derived B-cell receptors (BCRs).6-8 Putative CLL antigens have been identified, including self-antigens, or antigens derived from common pathogens including viruses, bacteria, and fungi. 9 The idea that BCR signaling is important in CLL is supported by rece...