IntroductionIn patients with chronic lymphocytic leukemia (CLL) the characteristic accumulation of monoclonal mature B lymphocytes in the peripheral blood (PB), bone marrow (BM), and secondary lymphoid tissues (SLTs) is mostly attributed to defective in vivo apoptosis, whereas these cells undergo rapid cell death in vitro. 1,2 It has been demonstrated that ex vivo coculture of CLL cells with stromal cells enhances their survival, and a fraction of CLL cells proliferate in close contact with T lymphocytes and stromal cells within pseudofollicles. 3 Therefore, close contact to accessory cells in the BM and SLTs may contribute to their sustained in vivo survival. 2 This is further supported by the observation that CD38 expression associated with adverse outcome in CLL is up-regulated in response to activated T cells, and thus increased in tissues containing pseudofollicles. 4 In long-term in vitro cultures of PB mononuclear cells (PBMNCs) from CLL patients, an adherent cell population, called "nurse-like" cells (NLCs) can be obtained. 5 These NLCs express and produce chemokines, such as CXCL12 and CXCL13, which regulate trafficking of human CLL cells between PB, lymphoid organs, and BM, and thus promote interaction with the microenvironment necessary for their survival and proliferation. 6,7 Furthermore, matrix metalloproteinase-9 is upregulated in response to integrin, CXCL12, and CCR7 signaling via Erk activation in CLL cells and regulates migration and lymph node infiltration thereby contributing to disease progression. 8 Trafficking, directed migration and homing are complex processes that involve the coordinate activation of Rho GTPases, such as Rac and RhoA downstream of integrins, and chemokine receptors in lymphocytes. 9 Their activity varies in a cell and agonist-specific fashion and is dependent in part on their intracellular localization. 10 In this regard, the Src nonreceptor tyrosine kinase and its target focal adhesion kinase (FAK) are critical regulators of both RhoA and Rac. 11 RhoH, a hematopoietic-specific member of the RhoE/Rnd3 subfamily of GTPases was initially identified as hypermutable gene and translocation partner in human B-cell lymphomas suggesting its involvement in the pathogenesis of B-cell malignancies. [12][13][14][15] Rhoh Ϫ/Ϫ mice exhibit a profound T-cell defect because of impaired T-cell receptor (TCR)-mediated selection and maturation of thymocytes as RhoH is required for CD3 phosphorylation and recruitment of the protein tyrosine kinases Zap70 and Lck to the cellular membrane and immunologic synapse. [16][17][18][19] Although the functional importance of RhoH has been well defined in T cells, its role in B-cell development appears less clear. However, in human CLL samples RhoH expression correlates with expression of the unfavorable prognostic marker Zap70. We previously reported an attenuated disease onset in the absence of RhoH in an E-TCL1 Tg mouse model of CLL, 20 which seemed paradoxical given the lack of RhoH involvement in normal B-cell development and the severe T-cel...