Importantly, the prognostic value of CD49d expression over other flow cytometry-based markers such as CD38 and ZAP-70 is higher, as confirmed by a combined analysis of 2972 CLL cases, with CD49d high patients having significantly lower overall survival at 62% after 10 years of follow up, as compared to 84% in CD49d low patients [125]. This evidence concerns the gene ITGA4 and B-cell chronic lymphocytic leukemia.