The role of the microenvironment in the pathogenesis of CLL
Paolo Ghia, MD, PhD of Università Vita-Salute San Raffaele, Milan, Italy discusses how the microenvironment is one of the major players in the pathogenesis of chronic lymphocytic leukemia (CLL). Dr Ghia mentions focusing his talk specifically on the role of immunoglobulins and antigenic stimulation in CLL. There has been a long-standing search for the antigens that are binding to these immunoglobulins, in order to induce proliferation and survival of the cells. Therefore, data are being presented that are inline with this search. For many years, a number of antigens have been proposed (bacterial, viral, self). Now there is a new approach to the problem. It seems that CLL cells have the property of autonomous signaling; the immunoglobulin recognizes itself, however, this is probably not enough to induce the full proliferation of the cell. Building upon this theory, crystals of the immunoglobulin from distinct patients have been developed. Dr Ghia mentions results showing immunoglobulins recognizing themselves and that the binding portion of the immunoglobulin is different in sub-sets of patients. Evidence suggests the way the immunoglobulin binds to the cell, is probably associated with the biological behavior of the cell and also with the clinical outcome of the patient. Recorded at the 2016 International Workshop of the German CLL Study Group (GCLLSG) in Cologne, Germany.