Clinical implications of cancer gene mutations in patients with chronic lymphocytic leukemia treated with lenalidomide
2018
Lenalidomideis clinically active in chronic lymphocytic leukemia (CLL), but its effectiveness in the context of the CLL
mutationallandscape is unknown. We performed targeted capture sequencing of 295 cancer genes in specimens from 102 CLL patients with treatment-naive disease (TN patients) and 186 CLL patients with relapsed/refractory disease (R/R patients) who received
lenalidomide-based therapy at our institution. The most frequently
mutatedgene was SF3B1 (15%), followed by NOTCH1 (14%) and TP53 (14%), with R/R patients having significantly more TP53
mutationsthan TN patients.
Mutated
IGHVwas associated with an increased prevalence of MYD88
mutations(p=0.005) and del(13q) (p=0.028), whereas unmutated
IGHVwas associated with an increased prevalence of NOTCH1 (p=0.035) and
XPO1(p=0.047). Among all
lenalidomide-treated patients, del(17p) (p≤0.001), del(11q) (p=0.032), and complex karyotype (p=0.022), along with
mutationsin TP53 (p≤0.001), KRAS (p=0.034), and
DDX3X(p≤0.001), were associated with worse overall response (OR). R/R patients with SF3B1 and MGA
mutationshad significantly worse OR (p=0.025 and 0.035, respectively). TN and R/R patients with del(17p) and TP53
mutationshad worse overall survival (OS) and progression-free survival (PFS). In R/R patients, complex karyotype and SF3B1
mutationswere associated with worse OS and PFS;
DDX3X
mutationswere associated with worse PFS only. Weibull regression multivariate analysis revealed that TP53 aberrations—del(17p) and/or TP53
mutation—along with complex karyotype and SF3B1
mutations, were associated with worse OS in the R/R cohort. Taken together, cancer gene
mutationsin CLL contribute to the already comprehensive risk stratification and add to prognosis and response to treatment. The related trials were registered to https://clinicaltrials.gov as NCT00267059, NCT00535873, NCT00759603, NCT01446133, and NCT01002755.
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