IntroductionB-cell chronic lymphocytic leukemia (CLL) is a malignancy of mature monoclonal CD5 ϩ B cells that typically express low levels of surface IgM. The clinical course is highly variable, characterized by progressive disease and unfavorable prognosis in approximately half the cases and a relatively indolent disease and normal life span in the remaining patients. 1 Significant associations have recently been observed between the clinical course and certain features of the B-cell receptor (BCR), indicating that antigen stimulation and signaling may play an important role in the pathogenesis of this disease. 2,3 In particular, the leukemic cells of patients with progressive disease typically display BCRs encoded by unmutated immunoglobulin variable heavy-chain genes (IgV H ) and express the protein tyrosine kinase (PTK) ZAP-70, which plays an essential role in antigen receptor signaling in T cells. In contrast, CLL B cells from most patients with stable disease express mutated IgV H genes and lack ZAP-70. [4][5][6][7][8] The 2 subsets also appear to differ in their capacity to transmit BCR-derived stimuli because IgM ligation induced stronger signaling responses in CLL B cells from patients with a poor prognosis. [9][10][11] ZAP-70 is a key signaling molecule in T cells, where it couples the antigen-activated T-cell receptor (TCR) to downstream signaling pathways. 12 It is structurally homologous to Syk, a PTK that is involved in proximal BCR signaling. In normal B cells, stimulation of the BCR by antigen leads to phosphorylation of immunoreceptor tyrosine-based activation motifs (ITAMs) within the cytoplasmic tails of Ig␣ and Ig. Syk is subsequently recruited to these motifs and, following its activation by tyrosine phosphorylation, propagates the signal by activation of downstream signaling molecules, such as phosphatidylinositol 3-kinase (PI3K) and phospholipase C␥2 (PLC␥2). PI3K generates the key second messenger phosphatidylinositol-3,4,5-triphosphate, which recruits other BCR-signaling molecules to the membrane and activates the kinase Akt. Activation of PLC␥2 leads to the release of intracellular Ca 2ϩ and activation of protein kinase C (PKC). The signaling cascade proceeds with activation of mitogen-activated protein kinases (MAPKs), such as extracellular signal-regulated kinase (ERK), c-JUN NH 2 -terminal kinase (JNK) and p38 MAPK, and transcription factors, including nuclear factor-B (NF-B) and nuclear factor of activated T cells (NFAT). 13 The balance among the activation of these signaling molecules determines the B-cell response, which can include proliferation, survival, differentiation, or cell death.The functional significance of ZAP-70 expression in CLL B cells is still unclear. Experiments with avian lymphoma B cells have shown that ZAP-70 can restore some BCR-signaling events when Syk is not expressed, indicating a certain degree of functional homology between the 2 PTKs. 14 More recently, ZAP-70 was shown to undergo tyrosine phosphorylation and to associate with the BCR complex in antige...