In light of this study of de la Fuenta, our finding that VLA-4 high risk CLL cells are particularly sensitive to the absence of prosurvival stimuli from accessory cells was unexpected. However, our results are in complete consistency with the recent report by Coscia and colleagues who observed that Compound Library high-risk CLL cells with an unmutated IGHV status were extremely vulnerable when removed from microenvironmental protection. These differences between the risk groups might be based on alterations in microenvironment-induced NFkB signaling cascades. Thus, disrupting microenvironmental interactions, potentially in combination with NFkB targeting, bears particular therapeutic potential for patients with a MK-2206 2HCl negative molecular prognostic signature. Despite higher adhesion rates of VLA-4 positive CLL cells to stromal cells, a VLA-4 dependent adhesion-mediated survival support could not be confirmed in our study. Our results suggest a more complex scenario where CLL cells use VLA-4 for localization in protective niches rather than as a direct prosurvival molecule. This clearly does not reduce the therapeutic potential of VLA-4 antagonism, but rather suggests that the predominant effect of this interference will be reduction of malignant cell localization in protective microenvironmental niches such as bone marrow. We do also not exclude that VLA-4 mediated cell-cell contact may be a means to prime the stromal cells to secrete specific survival factors. VLA-4 low expressing cells appear to be less dependent on these cell-cell interactions and survival cascades. In summary, our data suggest that VLA-4, rather than CD38, is mainly responsible for the recirculation of high-risk CLL cells into BM and for high BM infiltration observed in CLL patients. VLA-4 seems to be necessary to position those cells that are highly dependent on accessory survival signals at the appropriate supportive niche. Consequently, drugs that interfere with the homing properties of these cells, e.g., the anti-VLA-4 antibody Natalizumab, may be of particular benefit for this high-risk patient subgroup, especially in combination with current cytotoxic therapies. Moreover, Natalizumab could be used to target residual CLL cells surviving in the BM after conventional treatments, forcing them back into the blood stream where they become more vulnerable to treatment.