Allogeneic stem-cell transplantation may overcome the adverse prognosis of unmutated VH gene in patients with chronic lymphocytic leukemia.
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.
Moreno
Carol
C
Department of Hematology, Institute of Hematology and Oncology, Hospital Clínic, Villarroel, 170, 08036 Barcelona, Spain.
Villamor
Neus
N
Colomer
Dolors
D
Esteve
Jordi
J
Martino
Rodrigo
R
Nomdedéu
Josep
J
Bosch
Francesc
F
López-Guillermo
Armando
A
Campo
Elías
E
Sierra
Jorge
J
Montserrat
Emili
E
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
D005819:Genetic Markers; D007143:Immunoglobulin Heavy Chains