White blood cell count at diagnosis and immunoglobulin variable region gene mutations are independent predictors of treatment-free survival in young patients with stage A chronic lymphocytic leukemia

Abstract

A comprehensive panel of clinical-biological parameters was prospectively evaluated at presentation in 112 patients with chronic lymphocytic leukemia (<65 years), to predict the risk of progression in early stage disease. Eighty-one percent were in Binet stage A, 19% in stages B/C. Treatment-free survival was evaluated as the time from diagnosis to first treatment, death or last follow up. In univariate analysis, advanced stage, hemoglobin, platelets, white blood cell, leukemic lymphocyte count, raised beta 2-microglobulin and LDH, unmutated immunoglobulin variable region genes, CD38, del(17p), del(11q) and +12, were significantly associated with a short treatment-free survival; the T/leukemic lymphocyte ratio was associated with a better outcome. Multivariate analysis of treatment-free survival in stage A patients selected a high white blood cell count and unmutated immunoglobulin variable region genes as unfavorable prognostic factors and a high T/leukemic lymphocyte ratio as a favorable one. At diagnosis, these parameters independently predict the risk of progression in stage A chronic lymphocytic leukemia patients.

Figure 1.

(A) TFS in CLL patients according to the IGHV mutational status. TFS of 39 IGHV unmutated and 70 IGHV mutated CLL patients. (B) TFS in CLL patients according to the WBC count. TFS of 33 CLL patients with a WBC ≥30x10⁹/L and 79 with a WBC <30x10⁹/L. (C) TFS in CLL patients according to T/CLL ratio. TFS of 62 CLL patients with a T/CLL ratio <0.2 and 50 with a T/CLL ratio ≥0.2.