Foon K A, Thiruvengadam R, Saven A, Bernstein Z P, Gale R P
Markey Cancer Center, Lexington, Kentucky.
Ann Intern Med. 1993 Jul 1;119(1):63-73. doi: 10.7326/0003-4819-119-1-199307010-00011.
Studies concerning the genetic relatedness between chronic lymphocytic leukemia and the more aggressive B-cell cancers that develop in about 10% of affected persons were reviewed. These B-cell cancers include large B-cell lymphoma (the Richter syndrome), prolymphocytic transformation, acute lymphoblastic leukemia, and multiple myeloma. Two possible relations were evaluated: development from the chronic lymphocytic leukemia clone (clonal evolution) and development of a genetically unrelated, independent second cancer.
An English-language medical literature search was done using MEDLINE (1982 to 1992) and CANCERLIT (1982 to 1992). An extensive manual search of the literature that included meeting abstracts and reports was also done. Approximately 500 articles, abstracts, and book chapters were identified; 102 were selected for detailed analysis.
Analysis of genetic relatedness between the two cancers considered concordance for immunoglobulin gene rearrangements, for immunoglobulin isotypes and idiotypes, and for cytogenetic abnormalities.
In the case of large B-cell lymphoma, generally thought to arise from the chronic lymphocytic leukemia clone, approximately one half of the patients had genetically unrelated cancers. In prolymphocytic transformation, all cases studied appeared to evolve from the chronic lymphocytic leukemia clone. The few studies of acute lymphoblastic leukemia and multiple myeloma showed genetic relatedness in some cases and unrelatedness in others. These data indicate that progression to more aggressive B-cell cancers in persons with chronic lymphocytic leukemia can result from either clonal evolution or from an independent transforming event.
对有关慢性淋巴细胞白血病与约10%的患者所发生的侵袭性更强的B细胞癌症之间遗传相关性的研究进行综述。这些B细胞癌症包括大B细胞淋巴瘤（里氏综合征）、幼淋巴细胞转化、急性淋巴细胞白血病和多发性骨髓瘤。评估了两种可能的关系：由慢性淋巴细胞白血病克隆发展而来（克隆进化）以及发生遗传上不相关的独立第二种癌症。
使用MEDLINE（1982年至1992年）和CANCERLIT（1982年至1992年）进行了英文医学文献检索。还对包括会议摘要和报告在内的文献进行了广泛的手工检索。共识别出约500篇文章、摘要和书籍章节；选择了102篇进行详细分析。
分析两种癌症之间的遗传相关性时考虑了免疫球蛋白基因重排、免疫球蛋白同种型和独特型以及细胞遗传学异常的一致性。
对于通常认为由慢性淋巴细胞白血病克隆产生的大B细胞淋巴瘤，约一半患者的癌症在遗传上不相关。在幼淋巴细胞转化中，所有研究的病例似乎都由慢性淋巴细胞白血病克隆演变而来。对急性淋巴细胞白血病和多发性骨髓瘤的少数研究表明，有些病例存在遗传相关性，而有些病例则没有。这些数据表明，慢性淋巴细胞白血病患者进展为侵袭性更强的B细胞癌症可能是由克隆进化或独立的转化事件导致的。
