[Molecular biology of CLL]

Recently, major advances have occurred in our understanding of the biology of chronic lymphocytic leukemia (CLL). CD5-positive CLL cells were once assumed to originate from immature, immunologically incompetent B lymphocytes, and to passively accumulate due to increased life time. In 1999, two research groups demonstrated that CLL, which is a morphologically uniform but clinically heterogenous disease, can be classified into two major subgroups on the basis of the mutational status of the immunoglobulin heavy chain (IgH) genes. It was also suggested that these two groups both originate from mature cells that have passed the antigen selection process. This hypothesis was confirmed by gene expression studies indicating a uniform pattern characteristic to memory cells, as well as specific B-cell receptor (BCR) structures supporting the existence of a functional antigen selection. The differences in the BCR signal transduction mechanisms may underlie the different clinical behavior in which zeta-associated tyrosine kinase (ZAP-70) may play a pivotal role, since elevated ZAP-70 expression is likely to be an unfavorable prognostic factor in CLL. The diagnostic testing for ZAP-70 expression plays an important role in the therapeutic decisions.