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Blood, 15 August 2002, Vol. 100, No. 4, pp. 1410-1416
NEOPLASIA
VH mutation status, CD38 expression level,
genomic aberrations, and survival in chronic lymphocytic
leukemia
Alexander Kröber,
Till Seiler,
Axel Benner,
Lars Bullinger,
Elsbeth Brückle,
Peter Lichter,
Hartmut Döhner, and
Stephan Stilgenbauer
From Abteilung Innere Medizin III, University of Ulm,
Germany; Zentrale Einheit Biostatistik and Abteilung Organisation
komplexer Genome, Deutsches Krebsforschungszentrum, Heidelberg,
Germany.
In chronic lymphocytic leukemia (CLL), biologic risk factors such
as immunoglobulin variable heavy chain gene
(VH) mutation status, CD38 expression level,
and genomic aberrations have recently been identified, but the relative
prognostic impact of the individual parameters is unknown. In the
current study, we analyzed VH mutation status
by polymerase chain reaction and sequencing (n = 300), genomic
aberrations by fluorescence in situ hybridization (+3q, 6q , +8q,
11q , +12q, 13q , t(14q), 17p ) (n = 300), and CD38 expression by
triple-color FACS (CD5, CD19, CD38) (n = 157) in a unicentric CLL
cohort. The prognostic influence of VH mutation rate and CD38 expression level was tested by maximally selected log-rank statistics. A corrected P value
(Pcor) for a cutoff level allowing the best
separation of 2 subgroups with different survival probabilities was
identified at 97% VH homology (95% confidence interval [CI], 96%-98% homology,
Pcor <.001) and at 7% CD38 expression (95%
CI, 20%-71% expression, Pcor = .02). In
univariate analyses, unmutated VH genes and
high CD38 expression levels predicted for shorter survival times. The
overall incidence of genomic aberrations was similar in the
VH unmutated and VH
mutated subgroups. High-risk genomic aberrations such as 17p and
11q occurred almost exclusively in the VH
unmutated subgroup, whereas favorable aberrations such as 13q and
13q as single abnormalities were overrepresented in the
VH mutated subgroup. In multivariate analysis,
unmutated VH, 17p deletion, 11q deletion, age,
WBC, and LDH were identified as independent prognostic factors,
indicating a complementary role of VH mutation
status and genomic aberrations to predict outcome in CLL.

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