- Jain, Preetesh;
- González, Graciela M Nogueras;
- Kanagal‐Shamanna, Rashmi;
- Rozovski, Uri;
- Sarwari, Nawid;
- Tam, Constantine;
- Wierda, William G;
- Thompson, Philip A;
- Jain, Nitin;
- Luthra, Rajyalakshmi;
- Quesada, Andres;
- Sanchez‐Petitto, Gabriela;
- Ferrajoli, Alessandra;
- Burger, Jan;
- Kantarjian, Hagop;
- Cortes, Jorge;
- O'Brien, Susan;
- Keating, Michael J;
- Estrov, Zeev
The degree of somatic hypermutation, determined as percent deviation of immunoglobulin heavy chain gene variable region sequence from the germline (IGHV%), is an important prognostic factor in chronic lymphocytic leukaemia (CLL). Currently, a cut-off of 2% deviation or 98% sequence identity to germline in IGHV sequence is routinely used to dichotomize CLL patients into mutated and unmutated groups. Because dissimilar IGHV% cut-offs of 1-5% were identified in different studies, we wondered whether no cut-off should be applied and IGHV% treated as a continuous variable. We analysed the significance of IGHV% in 203 CLL patients enrolled on the original frontline fludarabine, cyclophosphamide and rituximab (FCR) trial with a median of 10 years follow-up. Using the Cox Proportional Hazard model, IGHV% was identified as a continuous variable that is significantly associated with progression-free (PFS) and overall survival (OS) (P < 0·001). Furthermore, we validated this finding in 323 patients treated with FCR off-protocol and in the total cohort (n = 535). Multivariate analysis revealed a continuous trend. Higher IGHV% levels were incrementally associated with favorable PFS and OS in both FCR-treated cohorts (P < 0·001, both cohorts). Taken together, our data suggest that IGHV% is a continuous variable in CLL patients treated with FCR.