The objective of this study was to evaluate the prognostic significance of CRY1 expression in early-stage CLL, and its relationship with other well established prognostic markers in CLL.
Design and Methods
Chronic lymphocytic leukemia patients and samplesSeventy samples from previously untreated CLL patients (Binet stage A) were included in this study after informed consent was obtained. Clinical diagnosis was based on standard morphological and immunophenotypic criteria. Definition of progressive disease was based on the NCI guidelines. 15 Mononuclear cells (PBMC) were isolated from peripheral blood by Ficoll-Hypaque (Lymphoprep™) density centrifugation. Samples were then processed for CD19 + selection, FC analysis and DNA/RNA isolation.
Analysis of IgVH somatic mutation statusDNA was prepared using a standard protocol and IgVH gene rearrangements were performed using BIO-MED-2 primers. 16 We considered unmutated those samples with ≥98% homology with the closest germinal line.
RTqPCR assayscDNA was synthesized from 1.5 µg of total RNA using random hexanucleotides and SuperScriptII (Invitrogen) following the manufacturer's instructions. RTqPCR assays were carried out using "Hs00172734-m1 (CRY1), Hs00277148-m1 (ZAP70) and Hs00173425-m1 (LPL) primers and probe sets (TaqMan ® Gene Expression Assays, Applied Biosystems). Amplification of GUS gene was performed in all cases to normalize gene expression.
Interphase fluorescence in situ hybridization (FISH)A panel of commercially available probes (Vysis) was used to target chromosomes 11q22.3 (ATM), 13q14 (D13S25 and D13S319), 17p13 (TP53) deletions and trisomy 12 on blood smears according to a standard protocol.
ZAP70 flow cytometry assayIntracellular ZAP-70 expression was analyzed in 69 samples by FC according to Crespo et al. 17 with some modifications. We use an isotype control as negative control. Results ≥20% were considered positive.
Statistical analysisSignificant differences between groups were assessed by the Mann-Whitney test and considered significant when p values <0.05. All statistical calculations were performed using the SPSS 13.0 software. Progression free survival (PFS) was calculated from the date of diagnosis to disease progression or last followup. For more detailed information see the Online Supplementary Appendix.
Results and Discussion
CRY1 expression and IgVH mutational statusOut of the 70 Binet's stage A patients tested for IgVH mutational status, 50 were mutated in IgVH genes (71.4%). These percentages are slightly different from those reported in previous studies 6,18,19 because in most of them, patients with different stages of the disease were included.To assess the usefulness of CRY1 expression as surrogate marker for IgVH mutational status, we determined CRY1 by RTqPCR in CD19 + cell samples. The mean ± 2 SEM relative concentration in unmutated and mutated samples were: 0.311±0.081 and 0.034±0.023, respectively, p<0.0001 (Online Supplementary Figure S1).The optimal predictive model based on CRY1 expression in relation to IgVH mutationa...