Chronic Lymphocytic Leukemia (CLL) with Borderline Immunoglobulin Heavy Chain Mutational Status, a Rare Subgroup of CLL with Variable Disease Course
by
, , , and
Francesco Angotzi
1, 
Alessandro Cellini
1,
Valeria Ruocco
1,
Chiara Adele Cavarretta
1,
Ivan Zatta
1,
Andrea Serafin
1,
Stefano Pravato
1,
Elisa Pagnin
1,
Laura Bonaldi
2,
Federica Frezzato
1,
Monica Facco
1,
Francesco Piazza
1,
Livio Trentin
1,* and
Andrea Visentin
1
1
Hematology Unit, Department of Medicine, University of Padova, 35128 Padua, Italy
2
Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS, 35128 Padua, Italy
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(6), 1095; https://doi.org/10.3390/cancers16061095
Submission received: 24 January 2024
/
Revised: 29 February 2024
/
Accepted: 6 March 2024
/
Published: 8 March 2024
(This article belongs to the Special Issue Clinical Research Advances in Chronic Lymphocytic Leukemia (CLL))
Simple Summary
In this study, we present a retrospective analysis of a large cohort of CLL patients with a particular focus on those with a borderline immunoglobulin heavy variable chain mutational status (BL-IGHV) and their disease course. BL-IGHV patients represent a relatively unexplored small fraction of CLL patients whose prognosis is still largely debated. Our work aims to provide further evidence regarding BL-IGHV CLL. The key findings of our research highlight differences in time to first treatment (TTFT) and overall survival (OS) between our cohort of borderline mutated patients and previous experiences, but also the relative similarities shared by BL-IGHV patients across the literature
Abstract
Chronic lymphocytic leukemia (CLL) exhibits substantial variability in disease course. The mutational status of the B-cell receptor immunoglobulin heavy variable (IGHV) chain is a critical prognostic factor, categorizing patients into mutated (M-IGHV) and unmutated (U-IGHV) groups. Recently, a third subgroup with borderline mutational status (BL-IGHV) has been identified, comprising approximately 5% of CLL cases. This study retrospectively analyzes the outcomes of 30 BL-IGHV mutated patients among a cohort of 653 CLL patients, focusing on time to first treatment (TTFT) and overall survival (OS). BL-IGHV patients had a short TTFT similar to U-IGHV patients (median 30.2 vs. 34 months; p = 0.9). Conversely, the OS of BL-IGHV patients resembled M-IGHV patients (median NR vs. 258 months; p = 1). Despite a similar incidence in unfavorable prognostic factors, the TTFT was shorter compared to other published cohorts. However, striking similarities with other experiences suggest that BL-IGHV mutated patients share common biological characteristics, biased IGHV gene usage and BCR subset frequency. These findings also underscore the need for multicentric efforts aggregating data on BL-IGHV CLL in order to elucidate its disease course and optimize therapeutic approaches for this rare subgroup. Until then, predicting outcomes and optimal management of BL-IGHV CLL will remain challenging.
