Monoclonal CD5+ and CD5- B-lymphocyte expansions are frequent in the peripheral blood of the elderly

Blood ◽  
2004 ◽  
Vol 103 (6) ◽  
pp. 2337-2342 ◽  
Author(s):  
Paolo Ghia ◽  
Giuseppina Prato ◽  
Cristina Scielzo ◽  
Stefania Stella ◽  
Massimo Geuna ◽  
...  

Abstract The responsiveness and diversity of peripheral B-cell repertoire decreases with age, possibly because of B-cell clonal expansions, as suggested by the incidence of serum monoclonal immunoglobulins and of monoclonal chronic lymphocytic leukemia (CLL)–like B lymphocytes in clinically silent adults. We phenotyped peripheral blood cells from 500 healthy subjects older than 65 years with no history or suspicion of malignancies and no evidence of lymphocytosis. In 19 cases (3.8%) a κ/λ ratio of more than 3:1 or less than 1:3 was found: 9 were CD5+, CD19+, CD23+, CD20low, CD79blow, sIglow (classic CLL-like phenotype); 3 were CD5+, CD19+, CD23+, CD20high, CD79blow, sIglow (atypical CLL-like), and 7 were CD5-, CD19+, CD20high, CD23-, CD79bbright, FMC7+, sIgbright (non–CLL-like). In 2 subjects, 2 phenotypically distinct unrelated clones were concomitantly evident. No cases were CD10+. Polymerase chain reaction (PCR) analysis demonstrated a monoclonal rearrangement of IgH genes in 15 of 19 cases. No bcl-1 or bcl-2 rearrangements were detected. Using a gating strategy based on CD20/CD5/CD79 expression, 13 additional CLL-like B-cell clones were identified (cumulative frequency of classic CLL-like: 5.5%). Thus, phenotypically heterogeneous monoclonal B-lymphocyte expansions are common among healthy elderly individuals and are not limited to classic CLL-like clones but may have the phenotypic features of different chronic lymphoproliferative disorders, involving also CD5- B cells.

Blood ◽  
2003 ◽  
Vol 101 (8) ◽  
pp. 3082-3084 ◽  
Author(s):  
Kathleen N. Potter ◽  
Jenny Orchard ◽  
Eustacia Critchley ◽  
C. Ian Mockridge ◽  
Annette Jose ◽  
...  

Abstract Chronic lymphocytic leukemia (CLL) comprises 2 subsets, distinguished by expression of unmutated or mutated VHgenes, with the former having a worse prognosis. Biased usage of the V1-69 gene is found in unmutated cases and is combined with selected D gene segments and JH6. It is controversial whether this is a CLL-associated feature or mirrors the normal B-cell pattern. Since CLL is a disease of the elderly, where changes in the B-cell repertoire may occur, we have analyzedV1-69 usage in the elderly (older than 75 years) population. Using monoclonal antibody (MoAb) G6, specific for 51p1-related V1-69 alleles, we found no increased expression with age. In 51p1-encoded immunoglobulin M (IgM), complementarity-determining region 3 (CDR3) length and frequency of D and JH genes were similar to those in the healthy young and distinct from those in CLL. These findings support the concept that CLL arises from B cells driven by antigen/superantigen and is not a stochastic event in the elderly B-cell population.


Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4402-4402
Author(s):  
Simon Schliffke ◽  
Mariela Sivina ◽  
Ekaterina Kim ◽  
Benjamin Thiele ◽  
Nuray Akyüz ◽  
...  

Abstract Disease-inherent and treatment-related immune dysfunction remain leading causes for morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). The advent of kinase inhibitors that target B cell receptor (BCR) signaling, which lack myelo- and T lymphocyte toxicity, raised hopes that these new agents may be less immunosuppressive and allow for better immune reconstitution when compared to chemo-immunotherapy (CIT). The effects of the BTK inhibitor ibrutinib or CIT with fludarabine, cyclophosphamide and rituximab (FCR) on the normal B cell repertoire have not been well characterized. Here, we used state-of-the-art immunosequencing technology to investigate how ibrutinib treatment affects the regeneration of non-malignant B-cells when compared to patients treated with FCR. Clinical data on infection rates and immunoglobulin levels was analyzed from 40 CLL patients treated with ibrutinib (median number of two pre-treatments) or frontline CIT with FCR at MD Anderson Cancer Center. In a representative subset of 20 patients, flow cytometry and next generation sequencing (NGS) of the immunoglobulin heavy chain (IGH) gene locus was used to monitor non-malignant B-cell immune reconstitution for 24 months after start of treatment with ibrutinib or FCR. Comparison of ibrutinib treatment with CIT revealed that immunoglobulin levels remained stable and relatively low in both cohorts, except for an increase in IgA during ibrutinib treatment, as previously reported. NGS results showed that ibrutinib treatment significantly decreased the non-malignant B-cells count after 24 months of treatment, while the counts were quantitatively stable in the FCR cohort. Next, we determined the dynamics of non-malignant B-cell immune repertoire composition over treatment. Based on the mutational status of the V gene, non-malignant B-cells were classified as IGH hypermutated (<98% identity to the corresponding germline V gene, corresponding to antigen-experienced B-cells) or IGH unmutated (≥98% identity to the corresponding germline V gene, corresponding to antigen-naïve B-cells). Before treatment initiation, the mean percentage of antigen-experienced B-cells did not significantly differ between the groups (ibrutinib 39%, FCR 48%). After 24 months, a significant decrease of antigen-experienced B-cells was observed in the FCR cohort, while the ratio of antigen-experienced and antigen-naïve B-cells remained unchanged in ibrutinib treated patients (ibrutinib 39%, FCR 22%, p=0.01). Analysis of the IGH clonotype repertoire using the Shannon-Wiener and the inverse Simpson diversity indices confirmed these results, showing that the non-malignant IGH repertoire was composed of balanced numbers of antigen-experienced and antigen-naïve medium sized clones before treatment initiation in both cohorts. In line with the IGH repertoire shift towards antigen-naïve B-cells in FCR treated patients, the medium-sized clones disappeared after treatment, with large numbers of small-sized unmutated clones dominating after 24 months (p<0.0001). In ibrutinib treated patients, the repertoire diversity remained stable throughout the course of treatment. Taken together, our data indicate that continuous treatment with ibrutinib preserves preexisting (partially antigen-experienced) B-cells but impairs de-novo generation of naive B-cells. In contrast, FCR leads to a deletion of memory B-cells but also a subsequent substantial renewal of the B-cell repertoire. Both patterns may differentially affect immune-competence towards infections. Disclosures Bokemeyer: Karyopharm: Research Funding. Jain:Pfizer: Consultancy, Honoraria, Research Funding; Incyte: Research Funding; Genentech: Research Funding; Abbvie: Research Funding; Pharmacyclics: Consultancy, Honoraria, Research Funding; Infinity: Research Funding; Novartis: Consultancy, Honoraria; Servier: Consultancy, Honoraria; Novimmune: Consultancy, Honoraria; ADC Therapeutics: Consultancy, Honoraria, Research Funding; BMS: Research Funding; Celgene: Research Funding; Seattle Genetics: Research Funding. Wierda:Gilead: Research Funding; Abbvie: Research Funding; Novartis: Research Funding; Acerta: Research Funding; Genentech: Research Funding. Burger:Pharmacyclics: Research Funding.


Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1912-1912
Author(s):  
Dennis A. Carney ◽  
Srinivas R. Mummadi ◽  
Susan A. Lerner ◽  
Michael J. Keating

Abstract Paraproteins are found in 5–10% of CLL patients using conventional techniques and in a higher number using more sensitive techniques. The significance of this finding is uncertain although it has been suggested to be associated with a worse prognosis. When a paraprotein occurs with CLL it is usually considered to be a product of the leukemic clone. However there is an increased incidence of both B cell clonal expansions and monoclonal immunoglobulins (Igs) in the elderly suggesting an alternative source may exist. We examined the clinicopathological features of 34 cases of paraproteins who had an immunophenotype consistent with CLL (CD5+ B cells and CD23+ if tested). These were untreated patients who had an elevation of one or more immunoglobulins (Igs) on routine screening and subsequently had immunofixation (IF) to determine the presence of a paraprotein. In a database of chronic lymphoproliferative disorders 1380 patients had Ig quantitation and 168 were found to have an elevation in one or more Igs. Cases were excluded from this group if the disease was found to be T cell, CD5- or CD23-. This left 116 CLL patients with elevated Igs, of which 53 had IF. A polyclonal increase was detected in 19 and paraproteins in 34 (14 IgG, 16 IgM, 1 IgA and 3 oligoclonal). The level of paraprotein ranged from 0.2–4.4 g/dl for IgG, 0.2–2.4 g/dl for IgM and was 0.4 g/dl for IgA. Bence Jones Protein was associated with both IgG and IgM paraproteins when tested (2 patients in each group). Suppression of other Igs was observed in 12 patients (35%) with paraproteins and only one patient (5%) with a polyclonal increase. When compared to patients with a polyclonal increase in Igs, the patients with paraproteins had more advanced disease and higher bone marrow lymphocytosis, β2-microglobulin and LDH (p<0.05). The immunophenotype in approximately half of the cases in both groups was atypical for CLL with features including CD22+, CD79b+, FMC7+ and moderate to strong expression of surface Ig. Cytogenetic abnormalities were present in 8 of 34 cases with paraproteins but were not detected in the polyclonal group. The most frequent abnormality was trisomy 12 found in 4 cases. The survival of the 2 groups was not statistically different with a median follow up of 104 months. The origin of paraproteins is usually considered to be the CLL clone with CLL cells capable of secreting IgM as well as producing IgG and IgA paraproteins by isotype switching. In this cohort 5/14 patients with an IgG paraprotein had a different light chain expressed on the CLL clone. In addition 3/16 patients with IgM paraproteins had biclonal IgMs and in one case the 2 Igs had different light chains suggesting that at least one was not a product of the CLL clone. In conclusion, paraproteins in CLL are frequently not the product of the CLL clone but may reflect an associated age-related restriction in B cell repertoire and existence of other clonal expansions. Further studies are needed to determine if CLL emerges from one of these clones or develops independently.


Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4370-4370
Author(s):  
Francesco Forconi ◽  
Kathleen N Potter ◽  
Isla Wheatley ◽  
Nikos Darzentas ◽  
Elisa Sozzi ◽  
...  

Abstract Abstract 4370 The cell of origin of chronic lymphocytic leukemia (CLL) has long been sought and immunoglobulin gene analysis provides new clues. The immunoglobulin heavy variable gene (IGHV) status has clinical relevance in CLL, where two subsets, delineated by the absence or presence of somatic mutation, have markedly different prognoses. The unmutated subset (U-CLL), of inferior prognosis, appears to derive from a pre-germinal center B cell. In U-CLL, there is strikingly increased usage of the 51p1-related alleles of the IGHV1-69 gene, often combined with selected IGHD genes and with IGHJ6. Shared sequence “stereotypic” characteristics of the HCDR3 result, and suggest antigen selection of the leukemic clones. In this study, we have analyzed 147 51p1/IGHJ6 rearrangements from 3 healthy individuals (>51yr) and sought sequence patterns parallel to those of U-CLL. A pre-established dataset of 313 51p1/IGHJ6 rearrangements from patients with U-CLL was used as a reference. A high proportion (49/147, 33.3%) of normal sequences revealed stereotypic patterns, several (22/147, 15%) being similar to those described in U-CLL. Additional CLL-associated stereotypes, not yet reported, were detected in 7/147 sequences (4.8%). Stereotypes (13.6%) not detected in CLL were also found in 20/147 (13.6%) 51p1/IGHJ6 combinations. The HCDR2-IGHJ6 sequences were almost exclusively unmutated (143/147, 97,3% sequences had ≥98% homology to germline). Junctional amino acids in normal B cells were heterogeneous, as in the cases of CLL with stereotyped 51p1/IGHJ6 B-cell receptors. Normal B cells expressing 51p1-derived IgM (4.8% of all B-cells) had a phenotype of naïve B-cells, similar to 51p1-negative (CD27-) B cells, i.e. IgM+ IgD+ CD23+ CD38+, with a small percentage of CD5+ B cells, not found in the memory B-cell subset. This snapshot of the naïve B-cell repertoire reveals subsets of B cells closely related to those characteristic of CLL. Conserved patterns in the 51p1-encoded IgM of normal B cells suggest a restricted sequence repertoire shaped by evolution to recognize common pathogens. Proliferative pressure on these cells is the likely route to U-CLL. Disclosures: No relevant conflicts of interest to declare.


Blood ◽  
2010 ◽  
Vol 115 (1) ◽  
pp. 71-77 ◽  
Author(s):  
Francesco Forconi ◽  
Kathleen N. Potter ◽  
Isla Wheatley ◽  
Nikos Darzentas ◽  
Elisa Sozzi ◽  
...  

Abstract The cell of origin of chronic lymphocytic leukemia (CLL) has long been sought, and immunoglobulin gene analysis provides new clues. In the unmutated subset (U-CLL), there is increased usage of the 51p1-related alleles of the immunoglobulin heavy chain variable 1-69 gene, often combined with selected genes and with immunoglobulin heavy chain diversity IGHJ6. Stereotypic characteristics of the HCDR3 result and suggest antigen selection of the leukemic clones. We have now analyzed 51p1/IGHJ6 combinations in normal blood B cells from 3 healthy persons for parallel sequence patterns. A high proportion (33.3% of sequences) revealed stereotypic patterns, with several (15.0%) being similar to those described in U-CLL. Previously unreported CLL-associated stereotypes were detected in 4.8%. Stereotypes (13.6%) not detected in CLL also were found. The HCDR2-IGHJ6 sequences were essentially unmutated. Junctional amino acids in normal B cells were heterogeneous, as in cases of stereotyped CLL. Phenotypically, normal B cells expressing 51p1-derived immunoglobulin M were naive. This snapshot of the naive B-cell repertoire reveals subsets of B cells closely related to those characteristic of CLL. Conserved patterns in the 51p1-encoded immunoglobulin M of normal B cells suggest a restricted sequence repertoire shaped by evolution to recognize common pathogens. Proliferative pressure on these cells is the likely route to U-CLL.


Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 127-127
Author(s):  
Anindita Roy ◽  
Vojtech Bystry ◽  
Georg Bohn ◽  
Katerina Goudevenou ◽  
Tomas Reigl ◽  
...  

Abstract Introduction: Development of mature B cells depends upon the expression of a functional B cell receptor (BCR) and of its immunoglobulin (Ig) heavy (H) and light (L) chains. The molecular hallmark of B cell development, somatic recombination of the genes that encode the IgH (V, D and J) and IgL (V and J) chains, takes place in B cells in primary B lymphopoiesis sites throughout development (i.e. fetal liver (FL), fetal bone marrow (FBM) and adult BM). However, the spatiotemporal relationship between the IgH repertoire in FL with that in FBM, and the impact of the fetal Ig repertoire on the long-term repertoire present in post-natal life, as well as the link between this and the development of disease, are largely unknown. Aim: To gain insights into the ontogeny of the human innate B cell repertoire by performing high resolution analysis of the IgH-Cmu repertoire of human FL, FBM and post-natal B cells. Methods: CD34negCD19pos B cells from human 2nd trimester FL and FBM, child peripheral blood (cPB) and adult peripheral blood (aPB) were isolated by flow sorting. For initial assessment of the IgM repertoire ontogeny in FL and FBM B cells, we performed CDR3 fragment length analysis of VH1-VH6 families in the B cells. To gain further insights into the ontogeny of IgH diversification, we employed 454 next generation sequencing (NGS)-based analysis of the IgVH-Cmu mRNA repertoire in FL, FBM and postnatal B cells. In total, 20 libraries generated from 17 individual, flow-sorted CD34negCD19pos B cell samples were sequenced: 5 FL (4 performed in independent duplicate libraries; GA 14-18 weeks), 3 FBM (GA 13-17 weeks), 3 cPB (age 4mo-4yrs) and 5 aPB (age 29-53 yrs) samples. Bioinformatic analysis was performed with the ARResT/Interrogate immunoprofiler, IMGT tools, and appropriate statistics. Results: Spectratyping and NGS data showed that the molecular mechanisms responsible for VDJ recombination-dependent repertoire diversification, such as convergent recombination, are active in early B cell development and as efficient as postnatal B cells in both FL and FBM. Comparably diversified B cell lymphopoiesis exists contemporaneously in FL and FBM. However, analysis of the top 100 most abundant clonotypes in each developmental stage showed that their mean abundance in FBM B cells was 10 times lower (0.12%) than in FL B cells (1.2%; p<0.0001). Reflecting this relative paucity of expanded clonotypes amongst FBM B cells, analysis of the 100 most abundant clonotypes across all developmental stages showed that 0 were present in FBM, compared to 65 in FL, 23 in cPB, and 12 in aPB. We found that this paucity of clonotypic expansions in FBM is likely due to the significant decrease in sIgM-expressing transitional and naïve B cells compared to FL (FL: 4.76±0.8% vs. FBM: 1.9±0.4%, p<0.01; and FL: 2.8±0.9% vs. FBM: 0.7±0.2%, p<0.05 respectively). Strikingly, 0.4% of all fetal life clonotypes, comprising 18.7% of the whole repertoire, were shared with the PB IgM B cell repertoire in children and adults, a pattern that is particularly pronounced for the VH6-1 gene. Reflecting the presence of high abundance clonotypes in FL but not FBM, the mean abundance of the clonotypes shared between FL and postnatal B cells was 38-fold higher than that of FBM (0.77% v 0.02%, p=0.001). Selection of these shared or public clonotypes is likely to occur in an HLA- and thus T cell-independent manner, and is therefore consistent with IgM innate humoral immune responses. Lastly, chronic lymphocytic leukemia (CLL) is the most common IgM+ mature B cell malignancy with subsets of patients with stereotyped BCR collectively accounting for ~30% of cases; we found stereotypic IgH receptors corresponding to 16/19 major CLL subsets in 3/5 FL samples and in all FBM and postnatal samples. Conclusions: The lack of mature, antigen-responsive B cells in FBM and the pronounced clonotypic expansions in FL suggest that FL is the main source of IgM natural immunity during the 2nd trimester. Our results are consistent with persisting fetal IgM+ B cells being an important source of the natural IgM repertoire also in adult life. Further, the origins of specific stereotypic IgM+ BCR associated with CLL, can be traced back to fetal B cell lymphopoiesis, suggesting that persisting fetal B cells can be subject to malignant transformation late in life. Overall, these novel data provide unique insights into the ontogeny of physiological and malignant B lymphopoiesis that spans the human lifetime. Disclosures No relevant conflicts of interest to declare.


1993 ◽  
Vol 23 (11) ◽  
pp. 2945-2950 ◽  
Author(s):  
Gilles Dietrich ◽  
Francisco J. Varela ◽  
Vincent Hurez ◽  
Majida Bouanani ◽  
Michel D. Kazatchkine

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