One aim of this session given at the Torino CD38 Meeting in June, 2006 was to review the role of CD38 in B-cell Chronic Lymphocytic Leukemia (B-CLL), and its potential as a therapeutic target. CD38high B-CLL cases show activated phenotypic features as compared with CD38low cases. Moreover, a greater percentage of Ki-67 and telomerase activity is documented among CD38high cases. Also, CD38 is not merely a negative prognostic marker in B-CLL, but also a key element in the pathogenetic network underlying the disease. A large series of B-CLL cases investigating the CD38 expression on bone marrow B-cells identified CD38 value <10% as the cut-off predicting a longer time to treatment. However, neither CD38 nor ZAP-70 by themselves or in combination were able to anticipate IgVH mutational status. Transferring these findings into clinical ground, 3 groups of B-CLL cases were identified with significantly different clinical courses: i.e., low-risk (no negative prognostic factor), intermediate-risk (1 negative prognostic factor) and high-risk (2-3 negative prognostic factors) patients. Altogether these results suggest that: i) CD38-expressing cells present not only an activation status, but also a different stage differentiation with a more repeated turnover; ii) CD38 contributes to controlling a signaling pathway that confers to B-CLL cells an increased proliferative potential, enhancing aggressiveness of this variant; iii) different CD38 cut off values should be considered for peripheral blood and bone marrow; iv) CD38 seems to independently contribute to prognostic stratification of B-CLL.
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