THE PROGNOSTIC EFFECT OF GENES IN THE P53 PATHWAY IN CHRONIC LYMPHOCYTIC LEUKEMIA

Chronic lymphocytic leukemia (CLL) is the most common leukemia in the Western world, characterized by the accumulation of small, non-dividing B lymphocytes in various lymphoid tissues, bone marrow and blood. The disease prognosis is heterogenous. Clinical staging methods (Rai and Binet) are used to make individual therapeutic decisions in patients and to predict prognosis and tumor burden. The prognosis of patients with CLL during diagnosis is important in terms of long-term survival and remission of patients. Therefore, apart from classical staging methods, it is necessary to develop prognostic parameters that can predict the course of the disease genetically without predicting the prognosis of the disease. The determination of differences in gene expressions in CLL cases is effective in their use as molecular markers. On the other hand, p53 tumor suppressor gene and many genes located in the p53 pathway play a role in the development of various malignancies. The p53 pathway responds to stress by controlling DNA replication and cell division. Stress signals (DNA damage, hot or cold shock, hypoxia, etc.) are transmitted to the p53 protein through post-translational modifications. Activation of the p53 protein plays a role in cell cycle arrest, cell senescence, or at the onset of the apoptosis. Among the genes responsible for cell growth, proliferation and differentiation by MCL1, MDM2 and MDM4, and ATM, E2F1 and PTEN from cell cycle genes and BAX, BCL-2 and p53 from apoptotic genes located in the p53 pathway has been demonstrated by various genetic studies for the effect of CLL on prognosis and pathogenesis. This study reviews the p53 pathway and the anomalies in this pathway that effect of prognosis and pathogenesis on CLL.