Binet's staging system and VH genes are independent but complementary prognostic indicators in chronic lymphocytic leukemia.
OBJECTIVE
Rai's and Binet's staging systems have contributed significantly to the identification of major prognostic groups in chronic lymphocytic leukemia (CLL), though they fail to accurately predict disease progression at the individual level. Biologic factors, such as the mutational status of the immunoglobulin heavy-chain variable genes (VH, cytogenetics, CD38 expression, and some serum markers, have recently improved prognostic assessment in CLL. In this study, we analyzed the prognostic value of VH mutational status within the different stages of Binet's classification in 145 patients.


METHODS
Our series consisted of 83 VH mutated (MT) and 62 VH unmutated (UM) patients. MT cases predominated within Binet's stage A (70%), whereas UM cases predominated among stages B and C (62%).


RESULTS
Median overall survival (OS) was 84 months for UM patients and was not achieved for the MT group (70% 12-year survival, P <.0001). Concerning Binet's stage A, both median OS and progression-free survival were significantly shorter for UM patients when compared with those of MT patients (97 months v not achieved, P =.0017; and 42 v 156 months, P <.0001), which compared favorably with the classical A' and A" substaging. The VH mutational profile could also segregate stage B and C patients into two groups with different survival patterns (median OS, 78 v 120 months for UM and MT patients, respectively; P =.002).


CONCLUSIONS
The significant survival differences observed between the VH mutational groups, among stage A and stage B and C patients, indicate that Binet's classification and VH genes are independent prognostic variables and are most likely complementary.
Institut Pasteur, Paris, France.
Yuri
Y
Vasconcelos
Frédéric
F
Davi
Vincent
V
Levy
Pablo
P
Oppezzo
Christian
C
Magnac
Ariane
A
Michel
Mihoko
M
Yamamoto
Otto
O
Pritsch
Hélène
H
Merle-Béral
Karim
K
Maloum
Florence
F
Ajchenbaum-Cymbalista
Guillaume
G
Dighiero
D001938:Brazil; D018450:Disease Progression; D018572:Disease-Free Survival; D005602:France; D006801:Humans; D007135:Immunoglobulin Variable Region / Q000235:genetics*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000235:genetics* / Q000401:mortality / Q000473:pathology*; D008297:Male; D009154:Mutation; D009364:Neoplasm Recurrence, Local / Q000235:genetics* / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D016019:Survival Analysis; D014583:Uruguay
D007135:Immunoglobulin Variable Region