Original Article | Published:

Chronic lymphocytic leukemia

Targeted deep sequencing reveals clinically relevant subclonal IgHV rearrangements in chronic lymphocytic leukemia

Leukemia volume 31, pages 837845 (2017) | Download Citation

Abstract

The immunoglobulin heavy-chain variable region gene (IgHV) mutational status is considered the gold standard of prognostication in chronic lymphocytic leukemia (CLL) and is currently determined by Sanger sequencing that allows the analysis of the major clone. Using next-generation sequencing (NGS), we sequenced the IgHV gene from two independent cohorts: (A) 270 consecutive patient samples obtained at diagnosis and (B) 227 patients from the UK ARCTIC-AdMIRe clinical trials. Using complementary DNA from purified CD19+CD5+ cells, we demonstrate the presence of multiple rearrangements in independent experiments and showed that 24.4% of CLL patients express multiple productive clonally unrelated IgHV rearrangements. On the basis of IgHV-NGS subclonal profiles, we defined five different categories: patients with (a) multiple hypermutated (M) clones, (b) 1 M clone, (c) a mix of M-unmutated (UM) clones, (d) 1 UM clone and (e) multiple UM clones. In population A, IgHV-NGS classification stratified patients into five different subgroups with median treatment-free survival (TFS) of >280(a), 131(b), 94(c), 29(d), 15(e) months (P<0.0001) and a median OS of >397(a), 292(b), 196(c), 137(d) and 100(e) months (P<0.0001). In population B, the poor prognosis of multiple UM patients was confirmed with a median TFS of 2 months (P=0.0038). In conclusion, IgHV-NGS highlighted one quarter of CLL patients with multiple productive IgHV subclones and improves disease stratification and raises important questions concerning the pre-leukemic cellular origin of CLL.

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Acknowledgements

This research was supported by the 'Wallonie-Bruxelles International World' (WBI World), the IRIS-Recherche fund, and the Bekales Foundation and 'Les Amis de l’Institut Bordet'. BS is supported by a Télévie grant (FRS-FNRS—Fonds de la Recherche Scientifique—FNRS). AS, PR, AB, DV, PA and JM are supported by the NIHR Biomedical Research Centre (Oxford).

Author contributions

BS and AT were the principal investigators and took primary responsibility for the paper; BS and AT performed research and wrote the manuscript. DB, HD and JM provided help for the next-generation sequencing experiments. DV, LL and PA performed stereotyped receptor analysis, coverage checking and verified the statistics. TS performed the bioinformatics validation. RC, PR and AB participated to the scientific discussion and revised the manuscript; AS supervised and revised the manuscript and the research.

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The views expressed are those of the authors and not necessarily those of the Department of Health.

Author information

Author notes

    • B Stamatopoulos
    •  & A Timbs

    These authors contributed equally to this work.

Affiliations

  1. Oxford NIHR BRC Molecular Diagnostic Centre, John Radcliffe Site, Oxford University Hospitals, Oxford, UK

    • B Stamatopoulos
    • , A Timbs
    • , D Bruce
    • , R Clifford
    • , P Robbe
    • , A Burns
    • , J Mason
    • , H Dreau
    •  & A Schuh
  2. Laboratory of Clinical Cell Therapy, Jules Bordet Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium

    • B Stamatopoulos
  3. Nuffield Department of Laboratory Sciences, University of Oxford, Oxford, UK

    • B Stamatopoulos
    • , R Clifford
    • , P Robbe
    • , A Burns
    • , D V Vavoulis
    •  & P Antoniou
  4. Department of Physiology, Anatomy and Genetics, Computational Genomics Analysis and Training Programme, MRC Functional Genomics Unit, University of Oxford, Oxford, UK

    • T Smith
  5. Oxford Medical Genetics Laboratories, Oxford University Hospitals NHS Trust, Oxford, UK

    • L Lopez
  6. Department of Oncology, Translational Molecular Diagnostics Centre, University of Oxford, Oxford, UK

    • A Schuh

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The authors declare no conflict of interest.

Corresponding author

Correspondence to A Schuh.

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DOI

https://doi.org/10.1038/leu.2016.307

Supplementary Information accompanies this paper on the Leukemia website (http://www.nature.com/leu)

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