Survival analysis of 118 chronic lymphocytic leukemia patients with abnormal TP53 gene in the era of traditional immunochemotherapy
10.3760/cma.j.issn.0253-2727.2019.05.006
- VernacularTitle: 传统免疫化疗时代118例TP53基因异常慢性淋巴细胞白血病患者生存分析
- Author:
Xiaotong LI
1
;
Huayuan ZHU
;
Li WANG
;
Yi XIA
;
Jinhua LIANG
;
Jiazhu WU
;
Wei WU
;
Lei CAO
;
Lei FAN
;
Wei XU
;
Jianyong LI
Author Information
1. Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital. Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing 210029, China
- Publication Type:Journal Article
- Keywords:
Leukemia, lymphocytic, chronic;
Abnormal TP53 gene;
Immunotherapy;
Complex karyotype
- From:
Chinese Journal of Hematology
2019;40(5):378-383
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the survival and first-line immune-chemotherapy (CIT) of chronic lymphocytic leukemia (CLL) with abnormal TP53 gene in the era of traditional CIT.
Methods:The clinical data of 118 CLL patients diagnosed from January 2003 to August 2017 were collected. Survival was analyzed according to indicators including sex, age, Binet risk stratification, B symptoms, β2-microglobulin (β2-MG) , immunoglobulin heavy chain variable region gene (IGHV) mutation status, chromosome karyotype and TP53 gene deletion/mutation. The efficacy of first-line CIT of 101 CLL patients was further analyzed.
Results:Among 118 patients, median progression-free survival (PFS) was 12 (95%CI 10.148-13.852) months and median overall survival (OS) was 53 (95%CI 41.822-64.178) months, only 30.5% patients survived over 5 years. Low β2-MG<3.5 mg/L indicated longer PFS (P=0.027) , female and Binet A patients had longer OS (P=0.011 and 0.013, respectively) . Of 118 patients, 17 (14.4%) didn’t receive any therapy until follow-up time or the dead time. Among the 101 patients who received ≥1 CIT, median time to first treatment (TTFT) was 1 (0-62) months, patients in Binet A had longer TTFT (P<0.001) compared to the patients in Binet B/C. According to statistical needs, we divided those first-line CIT into four groups: there were 30 cases (29.7%) in mild chemotherapy group (mainly treated with nitrogen mustard phenylbutyrate or rituximab alone) , 32 cases (31.7%) in the fludarabine-containing group, 23 cases (22.8%) in high-dose methyprednisolone (HDMP) containing group and 16 cases (15.8%) in the other chemotherapy group. The first regimen contained HDMP can bring longer PFS (P<0.001) , however the OS between four groups had no statistical differences.
Conclusion:CLL patients with abnormal TP53 gene had poor response to immunotherapy, rapid clinical progressing, first-line immunotherapy containing HDMP can prolong PFS and will create an opportunity for patients to participate in clinical trials of novel drugs.
