Immunoglobulin heavy chain ([email protected]) translocations negatively impact treatment-free survival for chronic lymphocytic leukemia patients who have an isolated deletion 13q abnormality

      Immunoglobulin heavy chain translocations (t([email protected])) are suggested to portend a poor prognosis in chronic lymphocytic leukemia (CLL). To determine the clinical significance of a t([email protected]) on CLL-specific cytogenetic abnormalities, we analyzed the outcomes of 142 CLL patients referred for fluorescence in situ hybridization (FISH) analysis with our standard FISH panel, which includes testing for a t([email protected]). Whereas patients with unfavorable (deletion 17p, deletion 11q) and intermediate (trisomy 12, normal FISH) cytogenetics with concomitant t([email protected]) had similar median treatment-free survival (TFS) as those without a t([email protected]), patients with deletion 13q (del13q) and a t([email protected]) had significantly worse TFS than those without a t([email protected]): median TFS 4.7 versus 8.0 years, P = 0.03 (hazard ratio 4.21, 95% confidence interval 1.06–16.69 y, P = 0.04 in multivariate analysis after adjusting for age, sex, Rai stage, and white blood cell count). The presence of a t([email protected]) further stratified patients with del13q into two prognostic entities, whereby outcomes of those with coexistent del13q and a t([email protected]) were similar to outcomes of those with high risk cytogenetics. Knowledge of the t([email protected]) status in CLL is therefore of clinical importance, as del13q patients with concomitant t([email protected]) may not retain the previously expected favorable outcome.

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