title: The prognostic value of TP53 mutations in chronic lymphocytic leukemia is independent of Del17p13: implications for overall survival and chemorefractoriness.
abstract: OBJECTIVE
  Del17p13 predicts poor outcome and chemorefractoriness in chronic lymphocytic leukemia (CLL). Conversely, it is unknown whether TP53 mutations carry any prognostic value independent of del17p13. We tested the independent prognostic value of TP53 mutations in CLL.
  
  
  METHODS
  The study was based on a consecutive series of 308 CLL. DNA sequencing of TP53 exons 2 to 10 and del17p13 interphase fluorescence in situ hybridization were done at CLL diagnosis. Study end points were survival and chemorefractoriness.
  
  
  RESULTS
  At diagnosis, TP53 mutations (n = 32) occurred in 31 of 308 (10.0%) patients. Of all CLL showing TP53 disruption by either mutation and/or deletion (n = 44), 10 cases (22.7%) showed TP53 mutations in the absence of del17p13. Multivariate analysis selected TP53 mutations (hazard ratio, 3.20; P = 0.002) as an independent predictor of overall survival after adjustment for del17p13. Also, multivariate analysis selected TP53 mutations (hazard ratio, 3.97; P < 0.001) as an independent predictor of chemorefractoriness after adjustment for del17p13. Compared with cases without TP53 alterations, CLL harboring any type of TP53 disruption (mutation only, del17p13 only, or both mutation and del17p13) uniformly displayed a high prevalence of unfavorable prognosticators and poor outcome. Analysis of sequential CLL samples showed the acquisition of new or additional TP53 alterations at the time of chemorefractoriness.
  
  
  CONCLUSIONS
  These data show that (a) TP53 mutations are an independent predictor of short survival and chemorefractoriness, and (b) that CLL presenting with TP53 mutations without del17p13 fare as poorly as CLL carrying del17p13. Because CLL harboring TP53 mutations without del17p13 are currently not recognized by conventional diagnostic strategies, these results may be relevant for a comprehensive prognostic characterization of CLL.
authors.affiliation: Division of Hematology, Department of Clinical and Experimental Medicine and BRMA, Amedeo Avogadro University of Eastern Piedmont and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy. rossidav@med.unipmn.it
authors.forename: Davide
authors.initials: D
authors.lastname: Rossi
authors.forename: Michaela
authors.initials: M
authors.lastname: Cerri
authors.forename: Clara
authors.initials: C
authors.lastname: Deambrogi
authors.forename: Elisa
authors.initials: E
authors.lastname: Sozzi
authors.forename: Stefania
authors.initials: S
authors.lastname: Cresta
authors.forename: Silvia
authors.initials: S
authors.lastname: Rasi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: De Paoli
authors.forename: Valeria
authors.initials: V
authors.lastname: Spina
authors.forename: Valter
authors.initials: V
authors.lastname: Gattei
authors.forename: Daniela
authors.initials: D
authors.lastname: Capello
authors.forename: Francesco
authors.initials: F
authors.lastname: Forconi
authors.forename: Francesco
authors.initials: F
authors.lastname: Lauria
authors.forename: Gianluca
authors.initials: G
authors.lastname: Gaidano
mesh_terms: D000368:Aged; D002872:Chromosome Deletion; D002886:Chromosomes, Human, Pair 17; D019008:Drug Resistance, Neoplasm / Q000235:genetics; D005260:Female; D016158:Genes, p53; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000235:genetics* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011379:Prognosis