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

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Blank White blood cell count at diagnosis and immunoglobulin variable region

gene (IGHV) mutations are independent predictors of treatment-free survival in

young patients with stage A chronic lymphocytic leukemia

Ilaria Del Giudice1, Francesca Romana Mauro1, Stefania De Propris1, Simona

Santangelo1, Marilisa Marinelli1, Nadia Peragine1, Valeria Di Maio1, Mauro

Nanni1, Rita Barzotti1, Francesca Mancini1, e Armiento1, Francesca

Paoloni2, Guarini1, Robin Foa'1,*

1 Division of Hematology, Rome University, Italy;

2 GIMEMA Data Center, GIMEMA foundation, Rome, Italy

* Corresponding author; email: rfoa@...

ABSTRACT

A comprehensive panel of clinical-biologic 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%

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.