B-cell chronic lymphocytic leukemia (B-CLL. Indeed, the view that B-CLL cells are antigen-naive and resting is consistent with their appearance as small lymphocytes with high nuclear-to-cytoplasmic ratios 2 and their surface membrane coexpression of immunoglobulin M (IgM) and IgD, which usually marks virgin B cells. 3 Nonetheless, the concepts that B-CLL cells are homogeneous and similar among patients and that they resemble antigen-naive and resting B cells are currently being called into question. For example, the documentation of somatic mutations in the leukemic lymphocytes of greater than 50% of these patients [4][5][6][7] indicates that B-CLL cells are not necessarily similar among patients and that the disease is not homogeneous in this respect. In fact, B-CLL cases can be divided into at least 2 subgroups on the basis of the presence or absence of significant numbers of V gene mutations; these subgroups identify patients that follow strikingly dissimilar clinical courses. 8,9 Since the induction of immunoglobulin V gene mutations requires cellular activation and maturation induced by antigen receptor engagement, 10,11 B-CLL cells with immunoglobulin V gene mutations resemble antigen-experienced B cells that at one point in their evolution were activated and therefore are not antigen-naive. On the basis of this reasoning, the question arises as to whether B-CLL cells that exhibit immunoglobulin V genes with germ line-like sequences are indeed resting and antigen-naive or whether they also represent B cells that were stimulated out of the resting state by antigen but that did not accumulate mutations.In addition, other data suggest that in vivo activation, albeit abortive, can occur in B-CLL. For example, B-CLL cells can express elevations of cyclin D2 without increases of the other cyclins that follow in cell cycle progression. 12 Furthermore, B-CLL cells can exhibit constitutive translocation of nuclear factor of activated T cells (NF-ATp) 13 and phosphorylation of signal transducer and activator of transcription 1 (STAT-1) and STAT-3. 14 Finally, most B-CLL cells express CD23, a cell surface marker acquired after B-cell activation. [15][16][17][18] These findings suggest that certain B-CLL cells or their precursors may have been triggered and may have attempted to traverse the cell cycle, and may therefore not be resting or antigen-naive.To examine further the possibility that the leukemic cells from all B-CLL cases are antigen-experienced and exist in an activated
Patients, materials, and methods
Patients and healthy donorsThe Institutional Review Boards of North Shore University Hospital (Manhasset, NY) and Long Island Jewish Medical Center (New Hyde Park, NY) approved these studies. Informed consent was provided by all participants in accordance with the Declaration of Helsinki. A total of 61 cases diagnosed as B-CLL were studied. Laboratory data on a subset of these cases have been reported earlier. 3,7,8 Patients were selected for the present study on the basis of the availability of DNA sequences...