IGHV gene mutational status and 17p deletion are independent molecular predictors in a comprehensive clinical-biological prognostic model for overall survival prediction in chronic lymphocytic leukemia

Journal of Translational Medicine

Research

Dimitar G Efremov¹  Valter Gattei²  Pietro Bulian²  Gabriele Pozzato³  Roberto Marasca⁴  Marco Montillo⁵  Francesco Lauria⁶  Francesco Forconi⁶  Gianluca Gaidano⁷  Davide Rossi⁷  Giovanni Del Poeta⁸  Luca Laurenti⁹  Francesco Bertoni^1,10  Emanuele Zucca^1,10  Giovanni D'Arena^1,11 

[1] CNR Campus "A. Buzzati-Traverso", ICGEB Outstation-Monterotondo, Rome, Italy;Clinical and Experimental Onco-Hematology Unit, IRCCS Centro di Riferimento Oncologico, via Franco Gallini 2, 33170, Aviano (PN), Italy;Department of Internal Medicine and Haematology, Maggiore Hospital, Trieste, Italy;Department of Medical Sciences, Section of Internal Medicine and Hematology, University of Modena and Reggio Emilia, Modena, Italy;Department of Oncology/Hematology, Niguarda Ca'Granda Hospital, Milan, Italy;Division of Hematology and Transplant, University of Siena, Siena, Italy;Division of Hematology, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy;Hematology, Tor Vergata University, Rome, Italy;Institute of Haematology, Catholic University of the Sacred Heart, Rome, Italy;Laboratory of Experimental Oncology and Lymphoma Unit, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland;Onco-Hematology Department, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture (Pz), Italy;

关键词: Chronic lymphocytic leukaemia;    Prognosis;    Prognostic score;    Nomogram;   

DOI  :  10.1186/1479-5876-10-18

 received in 2011-06-22, accepted in 2012-01-30,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundPrognostic index for survival estimation by clinical-demographic variables were previously proposed in chronic lymphocytic leukemia (CLL) patients. Our objective was to test in a large retrospective cohort of CLL patients the prognostic power of biological and clinical-demographic variable in a comprehensive multivariate model. A new prognostic index was proposed.MethodsOverall survival and time to treatment in 620 untreated CLL patients were analyzed retrospectively to evaluate the multivariate independence and predictive power of mutational status of immunoglobulin heavy chain variable gene segments (IGHV), high-risk chromosomal aberration such as 17p or 11q deletions, CD38 and ZAP-70 expression, age, gender, Binet stage, β2-microglobulin levels, absolute lymphocyte count and number of lymph node regions.ResultsIGHV mutational status and 17p deletion were the sole biological variables with independent prognostic relevance in a multivariate model for overall survival, which included easily measurable clinical parameters (Binet staging, β2-microglobulin levels) and demographics (age and gender). Analysis of time to treatment in Binet A patients below 70 years of age showed that IGHV was the most important predictor. A novel 6-variable clinical-biological prognostic index was developed and internally validated, which assigned 3 points for Binet C stage, 2 points/each for Binet B stage and for age > 65 years, 1 point/each for male gender, high β2-microglobulin levels, presence of an unmutated IGHV gene status or 17p deletion. Patients were classified at low-risk (score = 0-1; 21%), intermediate-risk (score 2-5; 63% of cases), high-risk (score 6-9; 16% of cases). Projected 5-year overall survival was 98%, 90% and 58% in low-, intermediate- and high-risk groups, respectively. A nomogram for individual patient survival estimation was also proposed.ConclusionsData indicate that IGHV mutational status and 17p deletion may be integrated with clinical-demographic variables in new prognostic tools to estimate overall survival.

【 授权许可】

CC BY   
© Bulian et al; licensee BioMed Central Ltd. 2012