The light chain IgLV3-21 defines a new poor prognostic subgroup in Chronic Lymphocytic Leukemia: results of a multicenter study

Purpose: Unmutated (UM) immunoglobulin heavy chainvariable region ( IgHV) status or IgHV3-21 gene usage is associated with poor prognosis in chronic lymphocytic leukemia (CLL) patients. Interestingly, IgHV3-21 is often co-expressed with light chain IgLV3-21, which is potentially able to trigger cell-autonomous BCR-mediated signaling. However, this light chain has never been characterized independently of the heavy chainIgHV3-21. Experimental Design: We performed total RNA sequencing in 32 patients and investigated IgLV3-21 prognostic impact in terms of treatment-free (TFS) and overall (OS) survival in 3 other independent cohorts for a total of 813 patients. IgLV3-21 presence was tested by real-time PCR and confirmed by Sanger sequencing. Results: Using total RNA sequencing to characterize 32 patients with high-risk CLL, we found a high frequency (28%) of IgLV3-21 rearrangements. Gene set enrichment analysis revealed that these patients express higher levels of genes responsible for ribosome biogenesisand translation initiation (Pl0.0001) as well as MYC target genes (P=0.0003). Patients with IgLV3-21 rearrangements displayed a significantly shorter TFS and OS (Pl0.05), particularly in IgHV-mutated patients. In each of the 3 independent validation cohorts, we showed that IgLV3-21 rearrangements -similar to UM IgHVstatus- conferred poor prognosis compared to mutated IgHV(Pl0.0001). Importantly, we confirmed by multivariate analysis that this was independent of IgHVmutational status or subset #2 stereotyped receptor (Pl0.0001). Conclusions: We have demonstrated for the first time that a light chain can impact CLL prognosis and that IgLV3-21 light chain usage defines a new subgroup of CLL patients with poor prognosis.