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CD49d expression is an independent risk factor of progressive disease in early stage chronic lymphocytic leukemia
Davide Rossi1, Antonella Zucchetto, Francesca Maria Rossi
1Division of Hematology, Department of Clinical and Experimental Medicine & BRMA, Amedeo Avogadro University of Eastern Piedmont, via Solaroli 17, 28100 Novara, Italy. rossidav@med.unipmn.it
Insights
High CD49d expression in Binet A chronic lymphocytic leukemia (CLL) patients indicates a poorer prognosis. This marker predicts shorter treatment-free survival and disease progression, aiding early risk assessment in CLL.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Accurate prognostic markers are crucial for managing Binet A chronic lymphocytic leukemia (CLL).
- Identifying patients with dismal prognoses allows for tailored treatment strategies.
Purpose of the Study:
- To evaluate the prognostic significance of CD49d expression in Binet A CLL.
- To determine if CD49d expression can predict treatment-free survival and disease progression.
Main Methods:
- CD49d expression was analyzed in 140 Binet A CLL patients at diagnosis.
- Association with proliferation markers (CD38, LDH, beta2-microglobulin) was assessed.
- Univariate and multivariate analyses were used to evaluate treatment-free survival, time to progression, and time to lymphocyte doubling.
Main Results:
- CD49d expression ≥30% was associated with proliferation markers (CD38, LDH, beta2-microglobulin).
- High CD49d expression was a significant risk factor for shorter treatment-free survival, time to progression, and time to lymphocyte doubling.
- Multivariate analysis confirmed CD49d ≥30% as an independent predictor of treatment-free survival.
Conclusions:
- CD49d expression ≥30% is a novel and independent prognostic marker for Binet A CLL.
- This marker identifies a subset of patients with a poor prognosis, even within favorable subgroups.
- CD49d expression should be considered in the initial prognostic assessment of Binet A CLL.
Abstract:
Identification of prognosticators for Binet A chronic lymphocytic leukemia is important for selecting patients with dismal prognosis. We analyzed CD49d expression in 140 consecutive Binet A chronic lymphocytic leukemia. At diagnosis, CD49d >or=30% (54/140, 38.6%) associated with proliferation markers, namely CD38 >or=30% (p=3.9 x 10(-6)), LDH (p=0.007) and beta2-microglobulin (p=0.020). Univariate log-rank analysis identified CD49d >or=30% as a risk factor of treatment free survival (p=8.3 x 10(-5)), time to progression to a more advanced stage (p=4.7 x 10(-4)), and time to lymphocyte doubling (p=0.009). Multivariate analysis selected CD49d >or=30% as an independent treatment free survival predictor after adjustment for biological (HR 2.28; 95% CI 1.71-4.45, p=0.015) and both biological and clinical variables analyzed together (HR 3.33, 95% CI 1.61-6.90, p=0.001). Within Binet A subgroups harboring favorable biological variables (IGHV homology <98%, favorable karyotype, CD38 <30%, ZAP70 <20%) or clinical variables, CD49d >or=30% consistently identified a subset of patients with short treatment free survival. Our observations indicate CD49d >or=30% as a new marker for the initial prognostic assessment of Binet A chronic lymphocytic leukemia.
