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LETTER TO THE EDITOR
Year : 2019  |  Volume : 8  |  Issue : 1  |  Page : 40-51

Chronic lymphocytic leukemia with deletion 17p: An Indian scenario


1 Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
2 Department of Lab Oncology, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication14-Jan-2019

Correspondence Address:
Dr. Ajay Gogia
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sajc.sajc_287_18

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How to cite this article:
Gogia A, Gupta R, Kumar L, Sharma A, Soni L. Chronic lymphocytic leukemia with deletion 17p: An Indian scenario. South Asian J Cancer 2019;8:40-51

How to cite this URL:
Gogia A, Gupta R, Kumar L, Sharma A, Soni L. Chronic lymphocytic leukemia with deletion 17p: An Indian scenario. South Asian J Cancer [serial online] 2019 [cited 2019 Apr 24];8:40-51. Available from: http://journal.sajc.org/text.asp?2019/8/1/40/250090

Dear Editor,

Deletion 17p (del 17p) is a rare genomic aberration found in patients with chronic lymphocytic leukemia (CLL). The incidence of del 17p varies from 5% to 9% in newly diagnosed patients with CLL while it is up to 50% in patients with relapsed/refractory disease.[1],[2] The presence of del 17p correlates with poor response to standard treatment and unfavorable outcome.[3] There is a paucity of data from India regarding del 17p in patients with CLL, and hence, we planned this study. The aim of this study is to know the incidence of del 17p in Indian patients with CLL and their clinicohematological characteristics. This prospective study included consecutive treatment-naïve patients who were diagnosed with CLL and registered at the Department of Medical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, New Delhi, between June 2013 and May 2018. The diagnoses of CLL was based on the guidelines from the International Workshop on CLL.[4] The baseline workup included cinical and hematological parameters (complete hemogram, peripheral blood smear examination, and flow cytometry), routine biochemistry, lactate dehydrogenase, B2 microglobulin, IgVH mutation status, and fluorescence in situ hybridization (FISH) for del 17 p. 17p deletion was assessed by FISH in peripheral blood samples at diagnosis using the commercially available dual color Zytolight TP53/Cen17 probe as per the manufacturer's recommendations (Zytovision, GmbH, Germany). For each patient, at least 200 interphase nuclei were analyzed by Olympus fluorescence microscope (Japan). The positive cases were defined as having ≥7.5% of nuclei. Patients were staged according to the Rai staging system.[5]

Of the 140 patients recruited in the study, del 17 p was found in 16 (11.4%) patients. The characteristics of these patients are summarized in [Table 1]. Among the patients positive for del 17p, 10 patients received treatment for CLL at baseline while 6 patients were kept under observation. In the subgroup of patients who received treatment, four patients received bendamustine rituximab, one patient received fludarabine cyclophosphamide and rituximab, one patient received chlorambucil and prednisolone, and four patients received ibrutinib. IgVH mutation status was available in 10 patients (sequences with a germline identity ≥98% were considered unmutated), 8 patients were found to have unmutated IgVH.[6]
Table 1: Baseline characteristics of chronic lymphocytic leukemia patients with deletion 17p (n = 16)

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This study is the first study from India evaluating the incidence of del 17p by utilizing FISH technique. In our study, del 17p was found in 11.4% treatment-naive patients with CLL which is higher than that reported in the western literature.[1],[2],[7] This may be due to a referral bias at our center or may reflect a difference in disease biology. The patients with 17p deletion were younger (53 vs. 59 years), had more male predominance (7:1 vs. 3:1), high total leukocyte count (60,000 vs. 50,000/mm3), and advanced disease (50% vs. 40%) at presentation when compared with the historic data from our institute.[8] This study is limited by unavailability of other cytogenetic abnormality by FISH.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Döhner H, Stilgenbauer S, Benner A, Leupolt E, Kröber A, Bullinger L, et al. Genomic aberrations and survival in chronic lymphocytic leukemia. N Engl J Med 2000;343:1910-6.  Back to cited text no. 1
    
2.
Zenz T, Gribben JG, Hallek M, Döhner H, Keating MJ, Stilgenbauer S, et al. Risk categories and refractory CLL in the era of chemoimmunotherapy. Blood 2012;119:4101-7.  Back to cited text no. 2
    
3.
Strati P, Keating MJ, O'Brien SM, Ferrajoli A, Burger J, Faderl S, et al. Outcomes of first-line treatment for chronic lymphocytic leukemia with 17p deletion. Haematologica 2014;99:1350-5.  Back to cited text no. 3
    
4.
Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, Döhner H, et al. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: A report from the international workshop on chronic lymphocytic leukemia updating the national cancer institute-working group 1996 guidelines. Blood 2008;111:5446-56.  Back to cited text no. 4
    
5.
Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN, Pasternack BS, et al. Clinical staging of chronic lymphocytic leukemia. Blood 1975;46:219-34.  Back to cited text no. 5
    
6.
Rani L, Mathur N, Gogia A, Vishnubhatla S, Kumar L, Sharma A, et al. Immunoglobulin heavy chain variable region gene repertoire and B-cell receptor stereotypes in Indian patients with chronic lymphocytic leukemia. Leuk Lymphoma 2016;57:2389-400.  Back to cited text no. 6
    
7.
Fischer K, Cramer P, Busch R, Böttcher S, Bahlo J, Schubert J, et al. Bendamustine in combination with rituximab for previously untreated patients with chronic lymphocytic leukemia: A multicenter phase II trial of the German chronic lymphocytic leukemia study group. J Clin Oncol 2012;30:3209-16.  Back to cited text no. 7
    
8.
Gogia A, Sharma A, Raina V, Kumar L, Vishnubhatla S, Gupta R, et al. Assessment of 285 cases of chronic lymphocytic leukemia seen at single large tertiary center in Northern India. Leuk Lymphoma 2012;53:1961-5.  Back to cited text no. 8
    



 
 
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