title: Clonal evolution including 14q32/IGH translocations in chronic lymphocytic leukemia: analysis of clinicobiologic correlations in 105 patients.
abstract: To better define the significance of clonal evolution (CE) including 14q32 translocations involving the immunoglobulin heavy chain gene (IGH) in chronic lymphocytic leukemia (CLL), 105 patients were analyzed sequentially by fluorescence in situ hybridization (FISH) with the following panel of probes: 13q14/D13S25, 11q22/ATM, 17p13/TP53, #12-centromere and 14q32/IGH break-apart probe. CE was observed in 15/105 patients after 24-170 months (median 64). Recurring aberrations at CE were 14q32/IGH translocation in seven patients; other aberrations were 17p -, 11q -, biallelic 13q - and 14q32 deletion. CE was detected in 15/58 pre-treated patients; in contrast, none of 47 untreated patients developed CE (p < 0.0001). In two cases the appearance of 14q32/IGH translocation was first detected in the bone marrow (BM) or in the lymph node (LN) and 13-58 months later in the peripheral blood (PB). ZAP70 + and high-risk cytogenetics predicted for the occurrence of CE with borderline statistical significance (p = 0.055 and 0.07, respectively). Shorter time to first treatment (TTT) and time to chemorefractoriness (TTCR) were noted in 15 patients with CE when compared to patients without CE (TTT: 35 vs. 71 months, p = 0.0033 and TTCR: 34 vs. 86 months, p = 0.0046, respectively). Survival after the development of CE was 32 months (standard error 8.5). We arrived at the following conclusions: (i) 14q32/IGH translocation may represent one of the most frequent aberrations acquired during the natural history of CLL and (ii) it may be detected earlier in BM or LN samples; (iii) CE including 14q32/IGH translocation occurs in pre-treated patients with short TTT and TTCR; (iii) survival after CE is relatively short.
authors.affiliation: Section of Hematology, Department of Biomedical Sciences, University of Ferrara, Ferrara, Italy. cvzfnc@unife.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavazzini
authors.forename: Lara
authors.initials: L
authors.lastname: Rizzotto
authors.forename: Olga
authors.initials: O
authors.lastname: Sofritti
authors.forename: Giulia
authors.initials: G
authors.lastname: Daghia
authors.forename: Francesca
authors.initials: F
authors.lastname: Cibien
authors.forename: Sara
authors.initials: S
authors.lastname: Martinelli
authors.forename: Maria
authors.initials: M
authors.lastname: Ciccone
authors.forename: Elena
authors.initials: E
authors.lastname: Saccenti
authors.forename: Melissa
authors.initials: M
authors.lastname: Dabusti
authors.forename: Abbas Awad
authors.initials: AA
authors.lastname: Elkareem
authors.forename: Antonella
authors.initials: A
authors.lastname: Bardi
authors.forename: Elisa
authors.initials: E
authors.lastname: Tammiso
authors.forename: Antonio
authors.initials: A
authors.lastname: Cuneo
authors.forename: Gian Matteo
authors.initials: GM
authors.lastname: Rigolin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002869:Chromosome Aberrations; D002883:Chromosomes, Human, Pair 14 / Q000235:genetics*; D060965:Clonal Evolution; D005260:Female; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics*; D017404:In Situ Hybridization, Fluorescence / Q000706:statistics & numerical data; D007621:Karyotyping; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000235:genetics*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016019:Survival Analysis; D013997:Time Factors; D014178:Translocation, Genetic; D051746:ZAP-70 Protein-Tyrosine Kinase / Q000235:genetics
chemical_list: D007143:Immunoglobulin Heavy Chains; D051746:ZAP-70 Protein-Tyrosine Kinase; C497261:ZAP70 protein, human