TY - JOUR
T1 - Importance of immunoglobulin heavy chain variable region mutational status in del(13q) chronic lymphocytic leukemia
AU - Gladstone, Douglas E.
AU - Swinnen, Lode
AU - Kasamon, Yvette
AU - Blackford, Amanda
AU - Gocke, Christopher D.
AU - Griffin, Constance A.
AU - Meade, Javier Bolanos
AU - Jones, Richard J.
PY - 2011/10
Y1 - 2011/10
N2 - Among prognostic factors for chronic lymphocytic leukemia (CLL), immunoglobulin heavy chain variable region (IGHV) mutation status and DNA analysis appear to be the most important. However, there is limited clinical outcome information for patients with the favorable-risk del(13q) and poor-risk unmutated IGHV. We retrospectively screened all patients with CLL at our institution between 2004 and June 2010 for del(13q) who also had an IGHV analysis. Unmutated IGHV was found in 38/79 patients; age, Rai stage, prior therapy, and time to evaluation were similar to those for patients with mutated IGHV. Unmutated patients were nearly four times more likely to harbor additional chromosomal aberrations compared to mutated patients (p<0.001). During a median follow-up of 4.5 years, unmutated patients were more likely to demonstrate Rai stage progression (69% vs. 31%, log-rank p<0.001) and to receive treatment (5-year cumulative probability of treatment: 65% vs. 32%, p<0.001). Patients with unmutated CLL also had a shorter overall survival (5-year survival probability: 72% vs. 100%, p<0.001). When limiting analysis to the 47 patients with del(13q) as a sole chromosomal abnormality, the 13 (28%) unmutated patients were more likely to demonstrate Rai progression (p<0.001), to receive treatment (p=0.02), and to have a shorter overall survival (p=0.13) than the 34 mutated patients. These data suggest that del(13q) conveys an indolent course only in patients with IGHV-mutated CLL.
AB - Among prognostic factors for chronic lymphocytic leukemia (CLL), immunoglobulin heavy chain variable region (IGHV) mutation status and DNA analysis appear to be the most important. However, there is limited clinical outcome information for patients with the favorable-risk del(13q) and poor-risk unmutated IGHV. We retrospectively screened all patients with CLL at our institution between 2004 and June 2010 for del(13q) who also had an IGHV analysis. Unmutated IGHV was found in 38/79 patients; age, Rai stage, prior therapy, and time to evaluation were similar to those for patients with mutated IGHV. Unmutated patients were nearly four times more likely to harbor additional chromosomal aberrations compared to mutated patients (p<0.001). During a median follow-up of 4.5 years, unmutated patients were more likely to demonstrate Rai stage progression (69% vs. 31%, log-rank p<0.001) and to receive treatment (5-year cumulative probability of treatment: 65% vs. 32%, p<0.001). Patients with unmutated CLL also had a shorter overall survival (5-year survival probability: 72% vs. 100%, p<0.001). When limiting analysis to the 47 patients with del(13q) as a sole chromosomal abnormality, the 13 (28%) unmutated patients were more likely to demonstrate Rai progression (p<0.001), to receive treatment (p=0.02), and to have a shorter overall survival (p=0.13) than the 34 mutated patients. These data suggest that del(13q) conveys an indolent course only in patients with IGHV-mutated CLL.
KW - CLL
KW - IGHV
KW - clinical outcomes
KW - del(13q)
KW - overall survival
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U2 - 10.3109/10428194.2011.585529
DO - 10.3109/10428194.2011.585529
M3 - Article
C2 - 21851216
AN - SCOPUS:80053206498
SN - 1042-8194
VL - 52
SP - 1873
EP - 1881
JO - Leukemia and Lymphoma
JF - Leukemia and Lymphoma
IS - 10
ER -