An extensive molecular cytogenetic characterization in high-risk chronic lymphocytic leukemia identifies karyotype aberrations and TP53 disruption as predictors of outcome and chemorefractoriness
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Gian Matteo Rigolin1,*, Luca Formigaro1,*, Maurizio Cavallari1, Francesca Maria Quaglia1, Enrico Lista1, Antonio Urso1, Emanuele Guardalben1, Sara Martinelli1, Elena Saccenti1, Cristian Bassi2, Laura Lupini2, Maria Antonella Bardi1, Eleonora Volta1, Elisa Tammiso1, Aurora Melandri1, Massimo Negrini2, Francesco Cavazzini1,*, Antonio Cuneo1,*
1Hematology Section, Department of Medical Sciences, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna, University of Ferrara, Italy
2Department of Morphology, Surgery and Experimental Medicine, and “Laboratorio per le Tecnologie delle Terapie Avanzate” (LTTA), University of Ferrara, Italy
*These authors contributed equally to this work
Gian Matteo Rigolin, email: firstname.lastname@example.org
Keywords: chronic lymphocytic leukemia, gene somatic mutations, next generation sequencing, karyotype: prognosis
Received: September 16, 2016 Accepted: February 21, 2017 Published: March 03, 2017
We investigated whether karyotype analysis and mutational screening by next generation sequencing could predict outcome in 101 newly diagnosed chronic lymphocytic leukemia patients with high-risk features, as defined by the presence of unmutated IGHV gene and/or 11q22/17p13 deletion by FISH and/or TP53 mutations. Cytogenetic analysis showed favorable findings (normal karyotype and isolated 13q14 deletion) in 30 patients, unfavorable (complex karyotype and/or 17p13/11q22 deletion) in 34 cases and intermediate (all other abnormalities) in 36 cases. A complex karyotype was present in 21 patients. Mutations were detected in 56 cases and were associated with unmutated IGHV status (p = 0.040) and complex karyotype (p = 0.047). TP53 disruption (i.e. TP53 mutations and/or 17p13 deletion by FISH) correlated with the presence of ≥ 2 mutations (p = 0.001) and a complex karyotype (p = 0.012). By multivariate analysis, an advanced Binet stage (p < 0.001) and an unfavorable karyotype (p = 0.001) predicted a shorter time to first treatment. TP53 disruption (p = 0.019) and the unfavorable karyotype (p = 0.028) predicted a worse overall survival. A shorter time to chemorefractoriness was associated with TP53 disruption (p = 0.001) and unfavorable karyotype (p = 0.025). Patients with both unfavorable karyotype and TP53 disruption presented a dismal outcome (median overall survival and time to chemorefractoriness of 28.7 and 15.0 months, respectively). In conclusion, karyotype analysis refines risk stratification in high-risk CLL patients and could identify a subset of patients with highly unfavorable outcome requiring alternative treatments.
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