Enhanced detection of chromosomal abnormalities in chronic lymphocytic leukemia by conventional cytogenetics using CpG oligonucleotide in combination with pokeweed mitogen and phorbol myristate acetate

Reproducible cytogenetic analysis in chronic lymphocytic leukemia (CLL) has been limited by the inability to obtain reliable metaphase cells for analysis. CpG oligonucleotide and cytokine stimulation have been shown to improve metaphase analysis of CLL cytogenetic abnormalities, but it is limited by variability in the cytokine receptor levels, stability, and biological activity of the cytokine in culture conditions and the high costs associated with these reagents. We report here use of a novel, stable CpG, GNKG168 along with pokeweed mitogen (PWM) and phorbol 12-myristate 13-acetate (PMA) for conventional cytogenetic assessment in CLL. We demonstrate that the combined use of GNKG168 + PWM/PMA increased the sensitivity of detection of chromosomal abnormalities compared to PWM/PMA (n = 207, odds ratio = 2.2, P = 0.0002) and GNKG168 (n = 219, odds ratio = 1.5, P = 0.0452). Further, a significant increase in sensitivity to detect complexity ≥3 with GNKG168 + PWM/PMA compared to GNKG168 alone (odds ratio 8.0, P = 0.0022) or PWM/PMA alone (odds ratio 9.6, P = 0.0007) was observed. The trend toward detection of higher complexity was significantly greater with GNKG168 + PWM/PMA compared to GNKG168 alone (P = 0.0412). The increased sensitivity was mainly attributed to the addition of PWM/PMA with GNKG168 because GNKG168 alone showed no difference in sensitivity for detection of complex abnormalities (P = 0.17). Comparison of fluorescence in situ hybridization (FISH) results with karyotypic results showed a high degree of consistency, although some complex karyotypes were present in cases with no adverse FISH abnormality. These studies provide evidence for potential use of GNKG168 in combination with PWM and PMA in karyotypic analysis of CLL patient samples to better identify chromosomal abnormalities for risk stratification.