A prognostic test for B-cell chronic lymphocytic leukemia
Chronic lymphocytic leukemia (CLL) is the most common type of adult leukemia in the Western world. The American Cancer Society estimated 15,340 new cases of CLL and 4500 deaths from the disease in the US in 2007. Most cases of CLL affect the B-cells, and this form of the disease is known as B-CLL.
CLL is present in two main stages – indolent and aggressive. Those with indolent disease can live for many years with few symptoms and little impact on their lives. Once the disease turns aggressive, progression is rapid (a few years) and mortality is high. Treating indolent disease is not advised, as early treatment can accelerate disease progression, and side effects of treatment can be harmful. The usual action is to “watch and wait” until the disease shows signs of progressing. In late stages, CLL is resistant to treatment (chemotherapy) and relapse often occurs. So it is important to know when to start treatment. Currently, there are several prognostic factors that are used to estimate the stage of the disease, but there are discordances among them and they do not indicate when the disease will progress.
Researchers at Sunnybrook Health Sciences Centre have developed a prognostic test that indicates whether a B-CLL patient is in the indolent or aggressive stage, and therefore whether treatment should be initiated. The test builds on their discovery of a new calcium-sensing receptor on the membrane of B cells. They have shown that leukemic B cells either release or don’t release intracellular calcium in response to extracellular calcium, and the difference in responsiveness correlates very closely with stage of the disease.
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