Guo Z, Jin H M, Qiu T L, Zhu L Y, Wu Y J, Qiu H R, Wang Y, Miao Y, Jin H, Fan L, Li J Y, Xia Y, Qiao C
Lymphoma Center, Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing 210029, China.
Zhonghua Xue Ye Xue Za Zhi. 2025 Mar 14;46(3):261-268. doi: 10.3760/cma.j.cn121090-20240819-00310.
To elucidate the genomic characteristics of the immunoglobulin (IG) heavy-chain variable region and light-chain variable region, the expression of subclones, and the prognostic significance in patients with CLL. Blood and/or bone marrow specimens were gathered from a cohort of 36 patients with CLL diagnosed at Jiangsu Province Hospital from December 2018 to May 2023, including 12 cases of B cell receptor (BCR) stereotyped patients. IG heavy-chain (IGH) and light-chain (IG Kappa [IGK] and IG lambda [IGL]) gene rearrangements were performed using next-generation sequencing (NGS) technology to analyze the characteristics and prognostic value in CLL. NGS detection of IG variable region (IGHV) demonstrated a significant correlation and superior consistency with Sanger sequencing (=0.957, < 0.001). Among the 36 patients, the IGH variant (IGHV) was observed in 9 (25.0%) but not in 27 (75.0%) participants. The incidence of the MYD88 mutation was higher among patients with mutated IGHV [1/27 (3.7%) 4/9 (44.4%), =0.00]. A high incidence of trisomy 12 was observed in the IGHV #8/#8B subset [4/11 (36.4%) 1/25 (4.0%), =0.023], which were more likely to develop Richter transformation [8/11 (72.7%) 4/25 (16.0%), =0.002]. In the patient cohort, 36 individuals (36/36, 100.0%) used the IGK variable, whereas 15 individuals (15/36, 41.7%) employed the IGL variable (IGLV). IGLV3 - 21 reported the highest utilization rate in IGLV (5/15, 33.3%). Remarkably, patients with CLL with IGLV3-21 fragments were exclusively observed in the Binet C stage and Rai Phase Ⅲ-Ⅳ, with an incidence of del (13) (q14) at 60.0% (3/5). The median time to first treatment (TTFT) of patients with or without IGLV3 - 21 fragments was 5.2 (1.1 - 41.5) and 9.9 (0.1 - 94.4) months, respectively. Using the total reads threshold of 2.5%, 4 (4/36, 11.1%) samples were detected to have two IGHV productive clones. The median TTFT and overall survival (OS) time were 2.8 (0.9-72.7) and 12.8 months in patients with one mutated clone and 57.5 (32.0-120.7) and 51.8 months in those with two mutated clones, respectively. The median TTFT and OS time were 10.9 (0.3-94.4) and 6.3 (0.1 - 12.5) months in patients with one unmutated clone and 49.9 (22.2 - 211.1) and 30.0 (9.6 - 50.3) months in those with multiple unmutated clones, respectively (>0.05) . Detection of IG gene rearrangements using NGS technology not only facilitates the analysis of the IGHV mutation status, dominant clones, and prognostic value but also contributes to the exploration of IGK/IGL gene rearrangement fragments and the utilization of subclones. Further, it provides information about the poor prognosis of IGLV3 - 21 CLL. The shortened survival of the two unmutated clone groups in the IGHV unmutated group may indicate a poor prognosis.
为阐明免疫球蛋白(IG)重链可变区和轻链可变区的基因组特征、亚克隆的表达情况以及对慢性淋巴细胞白血病(CLL)患者的预后意义。收集了2018年12月至2023年5月在江苏省人民医院确诊的36例CLL患者的血液和/或骨髓标本,其中包括12例B细胞受体(BCR)定型患者。采用下一代测序(NGS)技术进行IG重链(IGH)和轻链(IGκ[IGK]和IGλ[IGL])基因重排,以分析CLL中的特征和预后价值。NGS检测IG可变区(IGHV)与桑格测序显示出显著相关性和更高的一致性(=0.957,<0.001)。在36例患者中,9例(25.0%)观察到IGH变异(IGHV),27例(75.0%)未观察到。IGHV突变患者中MYD88突变的发生率更高[1/27(3.7%)对4/9(44.4%),=0.00]。在IGHV #8/#8B亚组中观察到12号三体的高发生率[4/11(36.4%)对1/25(4.0%),=0.023],这些患者更有可能发生Richter转化[8/11(72.7%)对4/25(16.0%),=0.002]。在患者队列中,36例个体(36/36,100.0%)使用IGK可变区基因,而15例个体(15/36,41.7%)使用IGL可变区基因(IGLV)。IGLV3 - 21在IGLV中的利用率最高(5/15,33.3%)。值得注意的是,携带IGLV3-21片段的CLL患者仅见于Binet C期和RaiⅢ-Ⅳ期,del(13)(q14)的发生率为60.0%(3/5)。有或无IGLV3 - 21片段患者的首次治疗中位时间(TTFT)分别为5.2(1.1 - 41.5)个月和9.9(0.1 - 94.4)个月。使用2.5%的总读数阈值,检测到4例(4/36,11.1%)样本有两个IGHV有功能克隆。一个突变克隆患者的中位TTFT和总生存期(OS)时间分别为2.8(0.9 - 72.7)个月和12.8个月,两个突变克隆患者分别为57.5(32.0 - 120.7)个月和51.8个月。一个未突变克隆患者的中位TTFT和OS时间分别为10.9(0.3 - 94.4)个月和6.3(0.1 - 12.5)个月,多个未突变克隆患者分别为49.9(22.2 - 211.1)个月和30.0(9.6 - 50.3)个月(>0.05)。使用NGS技术检测IG基因重排不仅有助于分析IGHV突变状态、优势克隆和预后价值,还有助于探索IGK/IGL基因重排片段和亚克隆的利用情况。此外,它提供了关于IGLV3 - 21 CLL预后不良的信息。IGHV未突变组中两个未突变克隆组生存期缩短可能表明预后不良。