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Chronic Lymphocytic Leukemia

The BCL-2 promoter (−938C>A) polymorphism does not predict clinical outcome in chronic lymphocytic leukemia

Abstract

The (−938C>A) polymorphism in the promoter region of the BCL-2 gene was recently associated with inferior time to treatment and overall survival in B-cell chronic lymphocytic leukemia (CLL) patients displaying the −938A/A genotype and may thus serve as an unfavorable genetic marker in CLL. Furthermore, the −938A/A genotype was associated with increased expression of Bcl-2. To investigate this further, we analyzed the −938 genotypes of the BCL-2 gene in 268 CLL patients and correlated data with treatment status, overall survival and known prognostic factors, for example, Binet stage, immunoglobulin heavy-chain variable (IGHV) mutational status and CD38 expression. In contrast to the recent report, the current cohort of CLL patients showed no differences either in time to treatment or overall survival in relation to usage of a particular genotype. In addition, no correlation was evident between the (−938C>A) genotypes and IGHV mutational status, Binet stage or CD38. Furthermore, the polymorphism did not appear to affect the Bcl-2 expression at the RNA level. Taken together, our data do not support the use of the (−938C>A) BCL-2 polymorphism as a prognostic marker in CLL and argue against its postulated role in modulating Bcl-2 levels.

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References

  1. Chiorazzi N, Rai KR, Ferrarini M . Chronic lymphocytic leukemia. N Engl J Med 2005; 352: 804–815.

    Article  CAS  Google Scholar 

  2. Delmer A, Ajchenbaum-Cymbalista F, Tang R, Ramond S, Faussat AM, Marie JP et al. Over-expression of cyclin D1 in chronic B-cell malignancies with abnormality of chromosome 11q13. Br J Haematol 1995; 89: 798–804.

    Article  CAS  Google Scholar 

  3. Obermann EC, Went P, Tzankov A, Pileri SA, Hofstaedter F, Marienhagen J et al. Cell cycle phase distribution analysis in chronic lymphocytic leukaemia: a significant number of cells reside in early G1-phase. J Clin Pathol 2007; 60: 794–797.

    Article  CAS  Google Scholar 

  4. Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN, Pasternack BS . Clinical staging of chronic lymphocytic leukemia. Blood 1975; 46: 219–234.

    CAS  Google Scholar 

  5. Binet JL, Lepoprier M, Dighiero G, Charron D, D'Athis P, Vaugier G et al. A clinical staging system for chronic lymphocytic leukemia: prognostic significance. Cancer 1977; 40: 855–864.

    Article  CAS  Google Scholar 

  6. Dohner H, Stilgenbauer S, Benner A, Leupolt E, Krober A, Bullinger L et al. Genomic aberrations and survival in chronic lymphocytic leukemia. N Engl J Med 2000; 343: 1910–1916.

    Article  CAS  Google Scholar 

  7. Damle RN, Wasil T, Fais F, Ghiotto F, Valetto A, Allen SL et al. Ig V gene mutation status and CD38 expression as novel prognostic indicators in chronic lymphocytic leukemia. Blood 1999; 94: 1840–1847.

    CAS  Google Scholar 

  8. Hamblin TJ, Davis Z, Gardiner A, Oscier DG, Stevenson FK . Unmutated Ig V(H) genes are associated with a more aggressive form of chronic lymphocytic leukemia. Blood 1999; 94: 1848–1854.

    CAS  Google Scholar 

  9. Wiestner A, Rosenwald A, Barry TS, Wright G, Davis RE, Henrickson SE et al. ZAP-70 expression identifies a chronic lymphocytic leukemia subtype with unmutated immunoglobulin genes, inferior clinical outcome, and distinct gene expression profile. Blood 2003; 101: 4944–4951.

    Article  CAS  Google Scholar 

  10. Moshynska O, Sankaran K, Saxena A . Molecular detection of the G(−248)A BAX promoter nucleotide change in B cell chronic lymphocytic leukaemia. Mol Pathol 2003; 56: 205–209.

    Article  CAS  Google Scholar 

  11. Skogsberg S, Tobin G, Krober A, Kienle D, Thunberg U, Aleskog A et al. The G(−248)A polymorphism in the promoter region of the Bax gene does not correlate with prognostic markers or overall survival in chronic lymphocytic leukemia. Leukemia 2006; 20: 77–81.

    Article  CAS  Google Scholar 

  12. Thunberg U, Tobin G, Johnson A, Soderberg O, Padyukov L, Hultdin M et al. Polymorphism in the P2X7 receptor gene and survival in chronic lymphocytic leukaemia. Lancet 2002; 360: 1935–1939.

    Article  CAS  Google Scholar 

  13. Starczynski J, Pepper C, Pratt G, Hooper L, Thomas A, Hoy T et al. The P2X7 receptor gene polymorphism 1513 A → C has no effect on clinical prognostic markers, in vitro sensitivity to fludarabine, Bcl-2 family protein expression or survival in B-cell chronic lymphocytic leukaemia. Br J Haematol 2003; 123: 66–71.

    Article  CAS  Google Scholar 

  14. Frey UH, Nuckel H, Sellmann L, Siemer D, Kuppers R, Durig J et al. The GNAS1 T393C polymorphism is associated with disease progression and survival in chronic lymphocytic leukemia. Clin Cancer Res 2006; 12: 5686–5692.

    Article  CAS  Google Scholar 

  15. Kaderi MA, Murray F, Jansson M, Merup M, Karlsson K, Roos G et al. The GNAS1 T393C polymorphism and lack of clinical prognostic value in chronic lymphocytic leukemia. Leukemia Res 2007, doi:10.1016/j.leukres.2007.10.003.

    Article  CAS  Google Scholar 

  16. Moshynska O, Sankaran K, Pahwa P, Saxena A . Prognostic significance of a short sequence insertion in the MCL-1 promoter in chronic lymphocytic leukemia. J Natl Cancer Inst 2004; 96: 673–682.

    Article  CAS  Google Scholar 

  17. Tobin G, Skogsberg A, Thunberg U, Laurell A, Aleskog A, Merup M et al. Mcl-1 gene promoter insertions do not correlate with disease outcome, stage or VH gene mutation status in chronic lymphocytic leukaemia. Leukemia 2005; 19: 871–873.

    Article  CAS  Google Scholar 

  18. Reed JC . Bcl-2 and the regulation of programmed cell death. J Cell Biol 1994; 124: 1–6.

    Article  CAS  Google Scholar 

  19. Kroemer G . The proto-oncogene Bcl-2 and its role in regulating apoptosis. Nat Med 1997; 3: 614–620.

    Article  CAS  Google Scholar 

  20. Schena M, Larsson LG, Gottardi D, Gaidano G, Carlsson M, Nilsson K et al. Growth- and differentiation-associated expression of bcl-2 in B-chronic lymphocytic leukemia cells. Blood 1992; 79: 2981–2989.

    CAS  Google Scholar 

  21. Faderl S, Keating MJ, Do KA, Liang SY, Kantarjian HM, O'Brien S et al. Expression profile of 11 proteins and their prognostic significance in patients with chronic lymphocytic leukemia (CLL). Leukemia 2002; 16: 1045–1052.

    Article  CAS  Google Scholar 

  22. Aguilar-Santelises M, Rottenberg ME, Lewin N, Mellstedt H, Jondal M . Bcl-2, Bax and p53 expression in B-CLL in relation to in vitro survival and clinical progression. Int J Cancer 1996; 69: 114–119.

    Article  CAS  Google Scholar 

  23. Seto M, Jaeger U, Hockett RD, Graninger W, Bennett S, Goldman P et al. Alternative promoters and exons, somatic mutation and deregulation of the Bcl-2-Ig fusion gene in lymphoma. EMBO J 1988; 7: 123–131.

    Article  CAS  Google Scholar 

  24. Tsujimoto Y, Gorham J, Cossman J, Jaffe E, Croce CM . The t(14;18) chromosome translocations involved in B-cell neoplasms result from mistakes in VDJ joining. Science 1985; 229: 1390–1393.

    Article  CAS  Google Scholar 

  25. Young RL, Korsmeyer SJ . A negative regulatory element in the bcl-2 5′-untranslated region inhibits expression from an upstream promoter. Mol Cell Biol 1993; 13: 3686–3697.

    Article  CAS  Google Scholar 

  26. Nuckel H, Frey UH, Bau M, Sellmann L, Stanelle J, Durig J et al. Association of a novel regulatory polymorphism (−938C>A) in the BCL2 gene promoter with disease progression and survival in chronic lymphocytic leukemia. Blood 2007; 109: 290–297.

    Article  Google Scholar 

  27. Jaffe E, Harris N, Stein H, Vardiman J (eds). World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. IARC Press: Lyon, 2001.

    Google Scholar 

  28. Chen X, Kwok PY . Homogeneous genotyping assays for single nucleotide polymorphisms with fluorescence resonance energy transfer detection. Genet Anal 1999; 14: 157–163.

    Article  CAS  Google Scholar 

  29. Tobin G, Thunberg U, Johnson A, Eriksson I, Soderberg O, Karlsson K et al. Chronic lymphocytic leukemias utilizing the VH3-21 gene display highly restricted Vlambda2-14 gene use and homologous CDR3s: implicating recognition of a common antigen epitope. Blood 2003; 101: 4952–4957.

    Article  CAS  Google Scholar 

  30. van Dongen JJ, Langerak AW, Bruggemann M, Evans PA, Hummel M, Lavender FL et al. Design and standardization of PCR primers and protocols for detection of clonal immunoglobulin and T-cell receptor gene recombinations in suspect lymphoproliferations: report of the BIOMED-2 Concerted Action BMH4-CT98-3936. Leukemia 2003; 17: 2257–2317.

    Article  CAS  Google Scholar 

  31. Thunberg U, Johnson A, Roos G, Thorn I, Tobin G, Sallstrom J et al. CD38 expression is a poor predictor for VH gene mutational status and prognosis in chronic lymphocytic leukemia. Blood 2001; 97: 1892–1894.

    Article  CAS  Google Scholar 

  32. Hamblin TJ, Orchard JA, Ibbotson RE, Davis Z, Thomas PW, Stevenson FK et al. CD38 expression and immunoglobulin variable region mutations are independent prognostic variables in chronic lymphocytic leukemia, but CD38 expression may vary during the course of the disease. Blood 2002; 99: 1023–1029.

    Article  CAS  Google Scholar 

  33. Durig J, Naschar M, Schmucker U, Renzing-Kohler K, Holter T, Huttmann A et al. CD38 expression is an important prognostic marker in chronic lymphocytic leukaemia. Leukemia 2002; 16: 30–35.

    Article  CAS  Google Scholar 

  34. Hayat A, O'Brien D, O'Rourke P, McGuckin S, Fitzgerald T, Conneally E et al. CD38 expression level and pattern of expression remains a reliable and robust marker of progressive disease in chronic lymphocytic leukemia. Leuk Lymphoma 2006; 47: 2371–2379.

    Article  CAS  Google Scholar 

  35. Park BL, Kim LH, Cheong HS, Cho HY, Kim EM, Shin HD et al. Identification of variants in cyclin D1 (CCND1) and B-Cell CLL/lymphoma 2 (BCL2). J Hum Genet 2004; 49: 449–454.

    CAS  Google Scholar 

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Acknowledgements

This study was supported by grants from the Swedish Cancer Society, The Lion's Cancer Research Foundation, Uppsala, and the Swedish Society for Medical Research. We thank Juhani Vilpo for providing data concerning the patients treated in Tampere, Finland. The SNP genotyping was performed by the SNP Technology Platform, Department of Medical Sciences, Uppsala University (www.genotyping.se). We are grateful to Dr Mattias Jansson and Lesley Sutton for their technical advice and assistance in this study.

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Correspondence to R Rosenquist.

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Kaderi, M., Norberg, M., Murray, F. et al. The BCL-2 promoter (−938C>A) polymorphism does not predict clinical outcome in chronic lymphocytic leukemia. Leukemia 22, 339–343 (2008). https://doi.org/10.1038/sj.leu.2405042

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