TP53 mutation and survival in chronic lymphocytic leukemia.
OBJECTIVE
The precise prognostic impact of TP53 mutation and its incorporation into treatment algorithms in chronic lymphocytic leukemia (CLL) is unclear. We set out to define the impact of TP53 mutations in CLL.


METHODS
We assessed TP53 mutations by denaturing high-performance liquid chromatography (exons 2 to 11) in a randomized prospective trial (n = 375) with a follow-up of 52.8 months (German CLL Study Group CLL4 trial; fludarabine [F] v F + cyclophosphamide [FC]).


RESULTS
We found TP53 mutations in 8.5% of patients (28 of 328 patients). None of the patients with TP53 mutation showed a complete response. In patients with TP53 mutation, compared with patients without TP53 mutation, median progression-free survival (PFS; 23.3 v 62.2 months, respectively) and overall survival (OS; 29.2 v 84.6 months, respectively) were significantly decreased (both P < .001). TP53 mutations in the absence of 17p deletions were found in 4.5% of patients. PFS and OS for patients with 17p deletion and patients with TP53 mutation in the absence of 17p deletion were similar. Multivariate analysis identified TP53 mutation as the strongest prognostic marker regarding PFS (hazard ratio [HR] = 3.8; P < .001) and OS (HR = 7.2; P < .001). Other independent predictors of OS were IGHV mutation status (HR = 1.9), 11q deletion (HR = 1.9), 17p deletion (HR = 2.3), and FC treatment arm (HR = 0.6).


CONCLUSIONS
CLL with TP53 mutation carries a poor prognosis regardless of the presence of 17p deletion when treated with F-based chemotherapy. Thus, TP53 mutation analysis should be incorporated into the evaluation of patients with CLL before treatment initiation. Patients with TP53 mutation should be considered for alternative treatment approaches.
Zenz
Thorsten
T
University of Ulm, Ulm, Germany.
Eichhorst
Barbara
B
Busch
Raymonde
R
Denzel
Tina
T
Häbe
Sonja
S
Winkler
Dirk
D
Bühler
Andreas
A
Edelmann
Jennifer
J
Bergmann
Manuela
M
Hopfinger
Georg
G
Hensel
Manfred
M
Hallek
Michael
M
Döhner
Hartmut
H
Stilgenbauer
Stephan
S
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D002872:Chromosome Deletion; D002886:Chromosomes, Human, Pair 17 / Q000235:genetics; D003520:Cyclophosphamide / Q000008:administration & dosage; D004252:DNA Mutational Analysis / Q000706:statistics & numerical data; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000235:genetics*; D008297:Male; D015999:Multivariate Analysis; D009154:Mutation; D011379:Prognosis; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D016159:Tumor Suppressor Protein p53 / Q000235:genetics*; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives
D016159:Tumor Suppressor Protein p53; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine