title: Allogeneic stem-cell transplantation may overcome the adverse prognosis of unmutated VH gene in patients with chronic lymphocytic leukemia.
abstract: OBJECTIVE
  To investigate whether allogeneic stem-cell transplantation (allo-SCT) may overcome the negative impact of unmutated VH genes in the outcome of patients with chronic lymphocytic leukemia (CLL).
  
  
  METHODS
  We analyzed the outcome of patients who underwent SCT according to their VH mutational status.
  
  
  RESULTS
  Thirty-four patients (14 allo-SCT and 20 autologous SCT [auto-SCT]) presented unmutated VH genes and 16 patients presented mutated VH genes (nine allo-SCT and seven auto-SCT). Tumoral burden pre-SCT was significantly higher in the allo-SCT patients independent of the VH mutational status. The risk of relapse was significantly higher after auto-SCT (5-year risk, 61%; 95% CI, 44% to 84%) than after allo-SCT (5-year risk 12%, 95% CI, 3% to 44%; P < .05). In the unmutated group, 13 of 20 auto-SCT and two of 14 allo-SCT patients experienced disease progression, with a risk of relapse at 5 years of 66% (95% CI, 48% to 93%) v 17% (95% CI, 5% to 60%), respectively (P = .01).
  
  
  CONCLUSIONS
  These results show that allo-SCT may overcome the unfavorable effect of unmutated VH genes in patients with CLL.
authors.affiliation: Department of Hematology, Institute of Hematology and Oncology, Hospital Clínic, Villarroel, 170, 08036 Barcelona, Spain.
authors.forename: Carol
authors.initials: C
authors.lastname: Moreno
authors.forename: Neus
authors.initials: N
authors.lastname: Villamor
authors.forename: Dolors
authors.initials: D
authors.lastname: Colomer
authors.forename: Jordi
authors.initials: J
authors.lastname: Esteve
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: Josep
authors.initials: J
authors.lastname: Nomdedéu
authors.forename: Francesc
authors.initials: F
authors.lastname: Bosch
authors.forename: Armando
authors.initials: A
authors.lastname: López-Guillermo
authors.forename: Elías
authors.initials: E
authors.lastname: Campo
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
authors.forename: Emili
authors.initials: E
authors.lastname: Montserrat
mesh_terms: D000328:Adult; D000368:Aged; D004252:DNA Mutational Analysis; D018450:Disease Progression; D005260:Female; D005819:Genetic Markers; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics* / Q000378:metabolism; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000235:genetics* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D005819:Genetic Markers; D007143:Immunoglobulin Heavy Chains