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Redefining the prognostic likelihood of chronic lymphocytic leukaemia patients with borderline percentage of immunoglobulin variable heavy chain region mutations
Author(s) -
Raponi Sara,
Ilari Caterina,
Della Starza Irene,
Cappelli Luca V.,
Cafforio Luciana,
Piciocchi Alfonso,
Arena Valentina,
Mariglia Paola,
Mauro Francesca R.,
Gentile Massimo,
Cutrona Giovanna,
Moia Riccardo,
Favini Chiara,
Morabito Fortunato,
Rossi Davide,
Gaidano Gianluca,
Guarini Anna,
Del Giudice Ilaria,
Foà Robin
Publication year - 2020
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.16434
Subject(s) - ighv@ , chronic lymphocytic leukemia , cohort , medicine , fludarabine , immunoglobulin heavy chain , gastroenterology , antibody , immunology , oncology , leukemia , chemotherapy , cyclophosphamide
Summary In chronic lymphocytic leukaemia (CLL), caution is warranted regarding the clinical implications of immunoglobulin variable heavy chain region ( IGHV ) rearrangements with a ‘borderline’ (BL) percentage of mutations (i.e. 97–97·9% IGHV identity). We analysed the IGHV mutational status in 759 untreated CLL patients (cohort 1). BL‐CLL ( n = 36, 5%) showed a time to first treatment (TFT) similar to that of M‐CLL ( n = 338) and significantly longer than that of UM‐CLL ( n = 385), despite the enrichment in subset #2 cases. In fact, CLLs belonging to subset #2 ( n = 15/759, 2%) were significantly more frequent among BL‐CLLs ( n = 5/36, 14%), with a brief TFT. TFT of BL‐CLL remained comparable to that of M‐CLL also considering the 327 CLL patients evaluated at diagnosis. These findings were then validated in an independent cohort 2 of 759 newly diagnosed CLL patients (BL‐CLL: n = 11, 1·4%) and in all newly diagnosed patients from cohorts 1 and 2 ( n = 1 086, 84% stage A; BL‐CLL: n = 47, 4·3%). BL‐CLL at diagnosis showed a biological profile comparable to that of M‐CLL with a low frequency of unfavourable prognostic markers, except for a significant enrichment in subset #2. Our data suggest that the prognosis of BL‐CLL is good and similar to that of M‐CLL, with the exception of subset #2 cases.