The complex karyotype landscape in chronic lymphocytic leukemia allows the refinement of the risk of Richter syndrome transformation

Haematologica. 2022 Apr 1;107(4):868-876. doi: 10.3324/haematol.2021.278304.

Abstract

Complex karyotype (CK) at chronic lymphocytic leukemia (CLL) diagnosis is a negative biomarker of adverse outcome. Since the impact of CK and its subtypes, namely type-2 CK (CK with major structural abnormalities) or high-CK (CK with ≥5 chromosome abnormalities), on the risk of developing Richter syndrome (RS) is unknown, we carried out a multicenter real-life retrospective study to test its prognostic impact. Among 540 CLL patients, 107 harbored a CK at CLL diagnosis, 78 were classified as CK2 and 52 as high-CK. Twenty-eight patients developed RS during a median follow-up of 6.7 years. At the time of CLL diagnosis, CK2 and high-CK were more common and predicted the highest risk of RS transformation, together with advanced Binet stage, unmutated (U)-IGHV, 11q-, and TP53 abnormalities. We integrated these variables into a hierarchical model: high-CK and/or CK2 patients showed a 10-year time to RS (TTRS) of 31%; U-IGHV/11q- /TP53 abnormalities/Binet stage B-C patients had a 10-year TTRS of 12%; mutated (M)-IGHV without CK and TP53 disruption a 10-year TTRS of 3% (P<0.0001). We herein demonstrate that CK landscape at CLL diagnosis allows the risk of RS transformation to be refined and we recapitulated clinico-biological variables into a prognostic model.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Humans
  • Karyotype
  • Leukemia, Lymphocytic, Chronic, B-Cell* / diagnosis
  • Leukemia, Lymphocytic, Chronic, B-Cell* / genetics
  • Lymphoma, Large B-Cell, Diffuse*
  • Mutation
  • Retrospective Studies

Grants and funding

Funding: This work was supported by funds from Associazione Italiana per la Ricerca sul Cancro (A.I.R.C.) projects to LT (IG-25024), Gilead fellowship program 2018 to LT, Special Program ‘Metastatic disease: the key unmet need in oncology’, AIRC 5x1000 (No. 21198) to RF, Fondo di Ateneo per la Ricerca 2016, 2017 of the University of Ferrara to GMR and FC, Fondo di Incentivazione alla Ricerca 2017 of the University of Ferrara to GMR, Ministero dell’Istruzione, dell’Università e della Ricerca PRIN 2015 to AC (2015ZMRFEA). AV received a research fellowship from the University of Padua supported by ONLUS Ricerca per Credere nella Vita (RCV) odv, Padua, Italy. This study was approved by the local research ethics committee of Padua hospital and informed consent was obtained from all patients.