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Serum-soluble APRIL influences survival in patients with chronic lymphocytic leukemia

Background A proliferation-inducing ligand (APRIL) is a member of the tumor necrosis factor family. APRIL plays an important role in B-cell development; it activates chronic lymphocytic leukemia (CLL) cells by reacting with its receptors, enhancing immune recognition, proliferation, and survival of the leukemia cells. Aim The aim of this study was to determine the impact of serum-soluble APRIL levels detected at diagnosis in B-CLL patients, and their relationship with disease parameters and patient outcomes. Patients and methods Serum APRIL levels were estimated in 40 untreated B-CLL patients and 40 apparently healthy controls. Serum was withdrawn at diagnosis of untreated CLL disease and was tested by enzyme-linked immunosorbent assay. Results APRIL levels in peripheral blood samples were significantly higher in B-CLL patients than in normal participants. There were positive correlations between serum-soluble APRIL level, age, white blood cell count, peripheral blood lymphocyte count, CD38%, ZAP-70, and modified RAI staging. There were negative correlations between serum-soluble APRIL, hemoglobin level, and platelet count. During a 2-year follow-up, APRIL levels correlated with overall survival and disease-free survival. Conclusion APRIL is a powerful prognostic marker related to parameters of disease activity and staging and, more importantly, to overall survival and disease-free survival.