The number of signaling pathways altered by driver mutations in chronic lymphocytic leukemia impacts disease outcome

Christian Brieghel, Caspar da Cunha-Bang, Christina Westmose Yde, Ane Yde Schmidt, Savvas Kinalis, Ferran Nadeu, Michael Asger Andersen, Line Offenbach Jacobsen, Mette Klarskov Andersen, Lone Bredo Pedersen, Julio Delgado, Tycho Baumann, Mattias Mattsson, Larry Mansouri, Richard Rosenquist, Elias Campo, Finn Cilius Nielsen, Carsten Utoft Niemann*

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftArtikelForskningpeer review


Purpose: Investigation of signaling pathways altered by recurrent gene mutations and their clinical impact in a consecutive cohort of patients with newly diagnosed chronic lymphocytic leukemia (CLL). The heterogeneous clinical course and genetic complexity of CLL warrant improved molecular prognostication. However, the prognostic value of recurrent mutations at the time of diagnosis remains unclear. Experimental Design: We sequenced samples from 314 consecutive, newly diagnosed patients with CLL to investigate the clinical impact of 56 recurrently mutated genes assessed by next-generation sequencing. Results: Mutations were identified in 70% of patients with enrichment among IGHV unmutated cases. With 6.5 years of follow-up, 15 mutated genes investigated at the time of diagnosis demonstrated significant impact on time to first treatment (TTFT). Carrying driver mutations was associated with shorter TTFT and poor overall survival. For outcome from CLL diagnosis, the number of signaling pathways altered by driver mutations stratified patients better than the number of driver mutations. Moreover, we demonstrated gradual impact on TTFT with increasing number of altered pathways independent of CLL-IPI risk. Thus, a 25-gene, pathway-based biomarker assessing recurrent mutations refines prognostication in CLL, in particular for CLL-IPI low- and intermediate-risk patients. External validation emphasized that a broad gene panel including low burden mutations was key for the biomarker based on altered pathways. Conclusions: We propose to include the number of pathways altered by driver mutations as a biomarker together with CLL-IPI in prospective studies of CLL from time of diagnosis for incorporation into clinical care and personalized follow-up and treatment.

Sider (fra-til)1507-1515
Antal sider9
TidsskriftClinical Cancer Research
Udgave nummer6
StatusUdgivet - 15 mar. 2020


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