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Prognostic subgroups in B-cell chronic lymphocytic leukemia defined by specific chromosomal abnormalities.
- Source :
-
The New England journal of medicine [N Engl J Med] 1990 Sep 13; Vol. 323 (11), pp. 720-4. - Publication Year :
- 1990
-
Abstract
- Background and Methods: Specific chromosomal abnormalities have been shown to affect the overall survival of patients with acute leukemia, but the possibility that specific chromosomal defects may influence the course of B-cell chronic lymphocytic leukemia (CLL) is controversial. We assessed this possibility as follows: blood mononuclear cells from 433 patients with B-cell CLL in five European centers were cultured with B-cell mitogens, and banded metaphases were studied.<br />Results: Three hundred ninety-one patients could be evaluated cytogenetically, and 218 had clonal chromosomal changes. The most common abnormalities were trisomy 12 (n = 67) and structural abnormalities of chromosome 13 (n = 51; most involving the site of the retinoblastoma gene) and of chromosome 14 (n = 41). Patients with a normal karyotype had a median overall survival of more than 15 years, in contrast to 7.7 years for patients with clonal changes. Patients with single abnormalities (n = 113) did better than those with complex karyotypes (P less than 0.001). Patients with abnormalities involving chromosome 14q had poorer survival than those with aberrations of chromosome 13q (P less than 0.05). Among patients with single abnormalities, those with trisomy 12 alone had poorer survival than patients with single aberrations of chromosome 13q (P = 0.01); the latter had the same survival as those with a normal karyotype. A high percentage of cells in metaphase with chromosomal abnormalities, indicating highly proliferative leukemic cells, was associated with poor survival (P less than 0.001). Cox proportional-hazards analysis identified age, sex, the percentage of cells in metaphase with chromosomal abnormalities, and the clinical stage of the disease (Binet classification system) as independent prognostic variables.<br />Conclusions: Chromosomal analysis provides prognostic information about overall survival in addition to that supplied by clinical data in patients with B-cell CLL.
- Subjects :
- Adult
Aged
Aged, 80 and over
Chromosomes, Human, Pair 12
Chromosomes, Human, Pair 13
Chromosomes, Human, Pair 14
Female
Humans
Karyotyping
Leukemia, Lymphocytic, Chronic, B-Cell genetics
Male
Metaphase
Middle Aged
Multicenter Studies as Topic
Prognosis
Survival Rate
Trisomy
Chromosome Aberrations
Leukemia, Lymphocytic, Chronic, B-Cell mortality
Subjects
Details
- Language :
- English
- ISSN :
- 0028-4793
- Volume :
- 323
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- The New England journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 2201915
- Full Text :
- https://doi.org/10.1056/NEJM199009133231105