Cytogenetic and molecular cytogenetic analysis of B cell chronic lymphocytic leukemia: specific chromosome aberrations identify prognostic subgroups of patients and point to loci of candidate genes.

The most frequent chromosome aberrations in B cell chronic lymphocytic leukemia (B-CLL) detected by conventional chromosome banding analysis are trisomy 12 followed by structural abnormalities of the long arms of chromosomes 13, 14, and 11. Complex karyotypes, trisomy 12, and a '14q+' abnormality have been associated with inferior prognosis, whereas aberrations of 13q have been found in patients with a favorable outcome. However, the cytogenetic analysis of B-CLL by conventional banding techniques has remained a difficult task mainly due to the low in vitro mitotic activity of the tumor cells. Although B cell mitogens are used for cell culture, clonal chromosome aberrations are detected in only half of the B-CLL tumors. 'Interphase cytogenetics' by means of fluorescence in situ hybridization (FISH) circumvents this problem, because there is no need to induce the malignant cells to proliferate in vitro. Numerical and structural chromosome aberrations can be detected in non-dividing interphase cells as well as in metaphase spreads. By FISH, the most common chromosome abnormalities are deletions of 13q followed by deletions of 11q, trisomy 12, and deletions of 17p. Except for the TP53 gene at 17p13, no candidate gene affected by these aberrations has so far been identified. FISH will be instrumental for the identification of such genes because the recurrent aberrations, especially deletions, can be systematically delineated to the resolution level of several kb. Furthermore, based on the sensitive detection of chromosome abnormalities by FISH, more accurate correlations between chromosome abnormalities and prognosis can be performed. Deletion of the TP53 gene at 17p13 have already been shown to be one of the most important independent prognostic factors for survival. Other specific aberrations of clinical significance will likely be identified by the systematic application of interphase cytogenetics on a large series of patients.