Chemoimmunotherapy may overcome the adverse prognostic significance of 11q deletion in previously untreated patients with chronic lymphocytic leukemia.
BACKGROUND
An 11q22 deletion is considered an independent factor predicting poor survival in chronic lymphocytic leukemia (CLL).


METHODS
We searched the electronic CLL database for consecutive patients who presented to the M. D. Anderson Cancer Center Department of Leukemia from October 2003 to April 2007 with untreated CLL and who had an 11q22 deletion, detected by fluorescence in situ hybridization (FISH) analysis of bone marrow samples. FISH analysis was performed using the following probes: trisomy 12 (12p11.1-q11), TP53 (17p13.1), ATM (11q22.3), LAMP1 (13q34), and D13S319 loci (13q14.3).


RESULTS
Sixty-nine patients with untreated CLL with an 11q22 deletion were identified. The median patient age was 59 years (range, 26-81 years); 80% were men, 53% had Zubrod performance status>0, and 13% had Rai stage III to IV disease. Lymphadenopathy (massive), splenomegaly, anemia, and thrombocytopenia were present in 96% (12%), 19%, 9%, and 4%, respectively. In addition, 62% of patients had deletions in 13q, and 3% had trisomy 12. Forty patients required therapy for progressive disease. The overall response rates for FCR (fludarabine, cyclophosphamide, and rituximab), CFAR (FCR plus alemtuzumab), and rituximab plus granulocyte-macrophage colony-stimulating factor were 100%, 100%, and 33%, respectively. The 11q22 deletion was undetectable in 25 of 27 patients monitored after treatment using FISH analysis. The median follow-up was 17 months. At 1 and 3 years, the survival rates were 97% and 91%, respectively, and the relapse-free survival rates were 100% and 77%, respectively.


CONCLUSIONS
CLL with an 11q22 deletion was associated with high rates of response, survival, and relapse-free survival when treated with chemoimmunotherapy.
Tsimberidou
Apostolia-Maria
AM
Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. atsimber@mdanderson.org
Tam
Constantine
C
Abruzzo
Lynne V
LV
O'Brien
Susan
S
Wierda
William G
WG
Lerner
Susan
S
Kantarjian
Hagop M
HM
Keating
Michael J
MJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D000912:Antibodies, Neoplasm / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002872:Chromosome Deletion; D002880:Chromosomes, Human, Pair 11; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000235:genetics; D008297:Male; D008875:Middle Aged; D000069283:Rituximab; D015996:Survival Rate
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D058846:Antibodies, Monoclonal, Murine-Derived; D000912:Antibodies, Neoplasm; D007155:Immunologic Factors; D000074323:Alemtuzumab; D000069283:Rituximab