1737 - Incidence and Outcome of chronic lymphocytic leukemia with Deletion 17p: An Indian experience; challenges and opportunities

Background

Deletion 17p (del17p) is a rare genomic aberration found in patients with CLL and its incidence is 5-9% in untreated patients and 30- 50% of relapsed and refractory cases. The presence of del 17p correlates with poor response to chemotherapy and unfavourable outcome. There is a paucity of data regarding incidence and outcome of CLL patients with del 17p from India.

Methods

This prospective study included consecutive treatmentnaïve and relapsed/refractory patients who were diagnosed with CLL and registered at the Department of Medical Oncology, Dr. BRAIRCH, All India Institute of Medical Sciences, New Delhi, between June 2013 and December 2018. Del 17p was assessed by FISH in peripheral blood samples.

Results

Total 220 patients (150 new and 70 relapse/refractory) recruited in this study, del 17 p was found in 18 (12%) patients in new cases and 18 (25.5%) in relapsed/refractory cases. The median age in 36 cases were 57 years (35-80) with male:female ratio was 6:1. As per clinical Rai stage:5 cases were in stage 0 & I, 10 cases were in stage II, 8 cases were in stage III and 13 cases were in stage IV. ZAP-70 was positive in 58%, CD 38 was positive in 45%, CD49d was positive in 66% and 80% of cases were IGVH unmutated. Out of 18 newly diagnosed cases, 11 patients received treatment [ 4 – Ibrutinib, 4 -Bendamustine + Rituximab (BR), 2- Chlorambucil and Prednisolone (CP),1 -Fludarabine, cyclophosphamide and rituximab (FCR)] while 7 patients were kept under observation. The overall response rate was 63.6% and complete response was 4 (36.36%). Out of 18 Relapse/refractory cases, 15 patients were required treatment (4- Ibrutinib, 4- BR, 5 -RCHOP/RCVP, 2 CP] with an overall response rate of 40% and CR rate of 12%. Eighteen patients died (11-disease progression, 4 infections and 3 -other reasons). Eight patients developed Richter’s transformation and died. The median progression free survival and overall survival was 14 months and 24 months respectively.

Conclusions

This is the first study on CLL with del17 p reported from India. Its incidence is 12 % in upfront cases and 25.5% in relapsed /refractory cases. Chemoimmunotherapy has dismal outcome and Ibrutinib was used in a limited number of patients because of financial constraints.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.