Universität zu Köln

Herling, Carmen D., Coombes, Kevin R., Benner, Axel, Bloehdorn, Johannes, Barron, Lynn L., Abrams, Zachary B., Majewski, Tadeusz, Bondaruk, Jolanta E., Bahlo, Jasmin, Fischer, Kirsten, Hallek, Michael, Stilgenbauer, Stephan, Czerniak, Bogdan A., Oakes, Christopher C., Ferrajoli, Alessandra, Keating, Michael J. and Abruzzo, Lynne V. (2019). Time-to-progression after front-line fludarabine, cyclophosphamide, and rituximab chemoimmunotherapy for chronic lymphocytic leukaemia: a retrospective, multicohort study. Lancet Oncol., 20 (11). S. 1576 - 1587. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1474-5488

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Abstract

Background Fludarabine, cyclophosphamide, and rituximab (FCR) has become a gold-standard chemoimmunotherapy regimen for patients with chronic lymphocytic leukaemia. However, the question remains of how to treat treatment-naive patients with IGHV-unmutated chronic lymphocytic leukaemia. We therefore aimed to develop and validate a gene expression signature to identify which of these patients are likely to achieve durable remissions with FCR chemoimmunotherapy. Methods We did a retrospective cohort study in two cohorts of treatment-naive patients (aged >= 18 years) with chronic lymphocytic leukaemia. The discovery and training cohort consisted of peripheral blood samples collected from patients treated at the University of Texas MD Anderson Cancer Center (Houston, TX, USA), who fulfilled the diagnostic criteria of the International Workshop on Chronic Lymphocytic Leukemia, had received at least three cycles of FCR chemoimmunotherapy, and had been treated between Oct 10, 2000, and Oct 26, 2006 (ie, the MDACC cohort). We did transcriptional profiling on samples obtained from the MDACC cohort to identify genes associated with time to progression. We did univariate Cox proportional hazards analyses and used significant genes to cluster IGHV-unmutated samples into two groups (intermediate prognosis and unfavourable prognosis). After using cross-validation to assess robustness, we applied the Lasso method to standardise the gene expression values to find a minimum gene signature. We validated this signature in an external cohort of treatment-naive patients with IGHV-unmutated chronic lymphocytic leukaemia enrolled on the CLL8 trial of the German Chronic Lymphocytic Leukaemia Study Group who were treated between July 21, 2003, and April 4, 2006 (ie, the CLL8 cohort). Findings The MDACC cohort consisted of 101 patients and the CLL8 cohort consisted of 109 patients. Using the MDACC cohort, we identified and developed a 17- gene expression signature that distinguished IGHV-unmutated patients who were likely to achieve a long-term remission following front- line FCR chemoimmunotherapy from those who might benefit from alternative front-line regimens (hazard ratio 3.83, 95% CI 1.94-7.59; p< 0. 0001). We validated this gene signature in the CLL8 cohort; patients with an unfavourable prognosis versus those with an intermediate prognosis had a cause-specific hazard ratio of 1. 90 (95% CI 1.18-3.06; p=0.008). Median time to progression was 39 months (IQR 22-69) for those with an unfavourable prognosis compared with 59 months (28-84) for those with an intermediate prognosis. Interpretation We have developed a robust, reproducible 17-gene signature that identifies a subset of treatment-naive patients with IGHV-unmutated chronic lymphocytic leukaemia who might substantially benefit from treatment with FCR chemoimmunotherapy. We recommend testing the value of this gene signature in a prospective study that compares FCR treatment with newer alternative therapies as part of a randomised clinical trial.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Herling, Carmen D. UNSPECIFIED UNSPECIFIED UNSPECIFIED Coombes, Kevin R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Benner, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Bloehdorn, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Barron, Lynn L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Abrams, Zachary B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Majewski, Tadeusz UNSPECIFIED UNSPECIFIED UNSPECIFIED Bondaruk, Jolanta E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bahlo, Jasmin UNSPECIFIED UNSPECIFIED UNSPECIFIED Fischer, Kirsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Hallek, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Stilgenbauer, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Czerniak, Bogdan A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Oakes, Christopher C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ferrajoli, Alessandra UNSPECIFIED UNSPECIFIED UNSPECIFIED Keating, Michael J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Abruzzo, Lynne V. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-129499
DOI:	10.1016/S1470-2045(19)30503-0
Journal or Publication Title:	Lancet Oncol.
Volume:	20
Number:	11
Page Range:	S. 1576 - 1587
Date:	2019
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1474-5488
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language GENE MUTATION STATUS; INITIAL THERAPY; OPEN-LABEL; SURVIVAL; CANCER; MICROARRAY; REGIMEN; PHASE-3 Multiple languages Oncology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/12949