Telomere length predicts for outcome to FCR chemotherapy in CLL

Norris, Kevin, Hillmen, Peter, Rawstron, Andrew, Hills, Robert, Baird, Duncan M. ORCID: https://orcid.org/0000-0001-8408-5467, Fegan, Christopher D. ORCID: https://orcid.org/0000-0001-9685-0621 and Pepper, Chris 2019. Telomere length predicts for outcome to FCR chemotherapy in CLL. Leukemia 33 , pp. 1953-1963. 10.1038/s41375-019-0389-9

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Abstract

We have previously shown that dividing patients with CLL into those with telomeres inside the fusogenic range (TL-IFR) and outside the fusogenic range (TL-OFR) is powerful prognostic tool. Here, we used a high-throughput version of the assay (HT-STELA) to establish whether telomere length could predict for outcome to fludarabine, cyclophosphamide, rituximab (FCR)-based treatment using samples collected from two concurrent phase II studies, ARCTIC and ADMIRE (n = 260). In univariate analysis, patients with TL-IFR had reduced progression-free survival (PFS) (P < 0.0001; HR = 2.17) and shorter overall survival (OS) (P = 0.0002; HR = 2.44). Bifurcation of the IGHV-mutated and unmutated subsets according to telomere length revealed that patients with TL-IFR in each subset had shorter PFS (HR = 4.35 and HR = 1.48, respectively) and shorter OS (HR = 3.81 and HR = 2.18, respectively). In addition, the OS of the TL-OFR and TL-IFR subsets were not significantly altered by IGHV mutation status (P = 0.61; HR = 1.24 and P = 0.41; HR = 1.47, respectively). In multivariate modeling, telomere length was the dominant co-variable for PFS (P = 0.0002; HR = 1.85) and OS (P = 0.05; HR = 1.61). Taken together, our data suggest that HT-STELA is a powerful predictor of outcome to FCR-based treatment and could be used to inform the design of future risk-adapted clinical trials.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Additional Information:	This article is licensed under a Creative Commons Attribution 4.0 International License
Publisher:	Springer Nature
ISSN:	0887-6924
Date of First Compliant Deposit:	1 February 2019
Date of Acceptance:	30 December 2018
Last Modified:	23 Mar 2024 18:47
URI:	https://orca.cardiff.ac.uk/id/eprint/119085

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