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Fogarty H, Dowling A, O'Brien D, Langabeer S, Bacon CL, Flavin R, O'Dwyer M, Hennessy B, O'Leary H, Crotty G, Henderson R, Nolan J, Thornton P, Vandenberghe E, Quinn F. Biclonal lymphoproliferative disorders: another association with NOTCH1-mutated chronic lymphocytic leukaemias. Ir J Med Sci 2020; 190:1087-1094. [PMID: 33068240 DOI: 10.1007/s11845-020-02386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Biclonal lymphoid disorders, when two distinct lymphoproliferative disorders (LPD) co-exist, are rare (incidence of 1.4%) and associated with a poor prognosis. NOTCH1 mutations occur in 10% of CLL at diagnosis, associated with a short disease-free interval and increased risk of Richter's transformation. We hypothesised that the incidence of NOTCH1 mutations in CLL with a second LPD may be increased, because the mutation occurs early in leukaemogenesis, permitting clonal divergence. METHODS We identified 19 patients with biclonal LPD at diagnosis: 11 with CLL and a second LPD (group A) and 8 with a second distinct CLL (group B). NOTCH1 mutation analysis was performed and clinical outcome investigated. RESULTS Ten of 19 (52%) were NOTCH1 mutated: 5 in group A (45%) and 5 in group B (62.5%) with a favourable clinical outcome observed among this cohort with 28.7 (range 1-99) months of follow-up. CONCLUSION In conclusion, we identified a significant (52%) incidence of NOTCH1 mutations in CLL in the context of biclonal LPD, associated with an indolent clinical course.
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Affiliation(s)
- Helen Fogarty
- Department of Cancer Molecular Diagnostics, St. James's Hospital, Dublin, Ireland. .,Department of Haematology, St James's Hospital and Trinity College, Dublin, Ireland. .,Irish Centre for Vascular Biology, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - Anita Dowling
- Department of Cancer Molecular Diagnostics, St. James's Hospital, Dublin, Ireland.,Department of Haematology, St James's Hospital and Trinity College, Dublin, Ireland
| | - David O'Brien
- Department of Haematology, St James's Hospital and Trinity College, Dublin, Ireland
| | - Steve Langabeer
- Department of Cancer Molecular Diagnostics, St. James's Hospital, Dublin, Ireland
| | | | - Richard Flavin
- Department of Pathology, St James's Hospital, Dublin, Ireland
| | | | - Brian Hennessy
- Department of Haematology, Waterford University Hospital, Waterford, Ireland
| | - Hilary O'Leary
- Department of Haematology, Limerick University Hospital, Limerick, Ireland
| | - Gerard Crotty
- Department of Haematology, Midlands Regional Hospital, Tullamore, Ireland
| | - Robert Henderson
- Department of Haematology, Midlands Regional Hospital, Tullamore, Ireland
| | - James Nolan
- Department of Haematology, Limerick University Hospital, Limerick, Ireland
| | | | - Elisabeth Vandenberghe
- Department of Cancer Molecular Diagnostics, St. James's Hospital, Dublin, Ireland.,Department of Haematology, St James's Hospital and Trinity College, Dublin, Ireland
| | - Fiona Quinn
- Department of Cancer Molecular Diagnostics, St. James's Hospital, Dublin, Ireland
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