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It is the quintessential example of a human malignancy that primarily involves defects in the induction of programmed cell death. An abnormal karyotype is observed in about 50% of patients with B-CLL. Patients with 13q14 abnormalities show heavy somatic mutation and have a benign disease. Trisomy 12 is associated with unmutated VH genes, atypical cellular morphology, and progressive disease. Extended cell survival is further shielded by a kinetic refractoriness likely promoted by abnormalities of the B-cell antigen receptor complex and favored by some cytokines that highlight a reciprocal dialog between malignant B and T cells. Because the tumor cells act as the major accessory cells, the accumulating malignant B-cell population per se is a hurdle to the production of normal antibodies and leads to a progressive and severe hypogammaglobulinemia. Conceivably, in the presence of certain immunoglobulin genes and when the T-cell control becomes deficient, activated malignant B cells may become able to present self-antigens and drive residual normal B cells to produce polyclonal autoantibodies restricted to self-antigens expressed only by blood cells and cause autoimmune cytopenias.<\/jats:p><jats:p>CONCLUSION: The distinctiveness of B-CLL B cells explains why B-CLL is different from other B-cell tumors and accounts for the development of immune deficiency and autoimmunity.<\/jats:p>","DOI":"10.1200\/jco.1999.17.1.399","type":"journal-article","created":{"date-parts":[[2017,2,24]],"date-time":"2017-02-24T06:52:05Z","timestamp":1487919125000},"page":"399-399","source":"Crossref","is-referenced-by-count":321,"title":["B-Cell Chronic Lymphocytic Leukemia: A Bird of a Different Feather"],"prefix":"10.1200","volume":"17","author":[{"given":"Federico","family":"Caligaris-Cappio","sequence":"first","affiliation":[{"name":"From the Dipartimento di Scienze Biomediche e Oncologia Umana, Universit\u00e0 di Torino, Ospedale Mauriziano Umberto I\u00b0, Torino e Istituto per la Ricerca e la Cura del Cancro (IRCC), Candiolo, Italy; and Department of Haematology and Oncology, Royal Bournemouth Hospital, Bournemouth BH7 7DW, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terry J.","family":"Hamblin","sequence":"additional","affiliation":[{"name":"From the Dipartimento di Scienze Biomediche e Oncologia Umana, Universit\u00e0 di Torino, Ospedale Mauriziano Umberto I\u00b0, Torino e Istituto per la Ricerca e la Cura del Cancro (IRCC), Candiolo, Italy; and Department of Haematology and Oncology, Royal Bournemouth Hospital, Bournemouth BH7 7DW, United Kingdom."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"233","reference":[{"key":"R2-0399","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V81.10.2475.2475"},{"key":"R3-0399","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199510193331606"},{"key":"R4-0399","unstructured":"Caligaris-Cappio F, Janossy G: Surface markers in chronic lymphoid leukemias of B cell type. 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