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Steinbrecher D, Jebaraj BMC, Schneider C, Edelmann J, Cymbalista F, Leblond V, Delmer A, Ibach S, Tausch E, Scheffold A, Bloehdorn J, Hallek M, Dreger P, Döhner H, Stilgenbauer S. Telomere length in poor-risk chronic lymphocytic leukemia: associations with disease characteristics and outcome. Leuk Lymphoma 2017; 59:1614-1623. [PMID: 29063805 DOI: 10.1080/10428194.2017.1390236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Telomere length in chronic lymphocytic leukemia (CLL) is described as an independent prognostic factor based largely on previously untreated patients from chemotherapy based trials. Here, we studied telomere length associations in high-risk, relapsed/refractory CLL treated with alemtuzumab in the CLL2O study (n = 110) of German and French CLL study groups. Telomere length (median 3.28 kb, range 2.52-7.24 kb) was relatively short, since 84.4% of patients had 17p- which is generally associated with short telomeres. Median telomere length was used for dichotomization into short and long telomere subgroups. Telomere length was associated with s-TK (p = .025) and TP53 mutations (p = .050) in untreated patients, while no association with clinical/biological characteristics was observed in relapsed/refractory CLL. Short telomeres had significant association with shorter PFS (p = .018) only in refractory CLL. Presence of short telomeres, loss of genes maintaining genomic integrity (SMC5) and increased incidence of chromothripsis, indicated the prevalence of genomic instability in this high-risk cohort (clinicaltrials.gov: NCT01392079).
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Affiliation(s)
| | | | - Christof Schneider
- a Department of Internal Medicine III , University of Ulm , Ulm , Germany
| | - Jennifer Edelmann
- b Barts Cancer Institute, Queen Mary University of London , London , UK
| | | | - Véronique Leblond
- d Service d'Hématologie , Hôpital Pitié-Salpêtrière , Paris , France
| | - Alain Delmer
- e Service d'Hématologie Clinique , CHU de Reims , Reims , France
| | - Stefan Ibach
- f WiSP Wissenschaftliche Service Pharma GmbH , Langenfeld , Germany
| | - Eugen Tausch
- a Department of Internal Medicine III , University of Ulm , Ulm , Germany
| | - Annika Scheffold
- a Department of Internal Medicine III , University of Ulm , Ulm , Germany
| | - Johannes Bloehdorn
- a Department of Internal Medicine III , University of Ulm , Ulm , Germany
| | - Michael Hallek
- g Internal Medicine I , University Cologne , Cologne , Germany
| | - Peter Dreger
- h Internal Medicine V , University of Heidelberg , Heidelberg , Germany
| | - Hartmut Döhner
- a Department of Internal Medicine III , University of Ulm , Ulm , Germany
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Adam R, Díez-González L, Ocaña A, Šeruga B, Amir E, Templeton AJ. Prognostic role of telomere length in malignancies: A meta-analysis and meta-regression. Exp Mol Pathol 2017; 102:455-474. [PMID: 28506770 DOI: 10.1016/j.yexmp.2017.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/18/2017] [Accepted: 05/11/2017] [Indexed: 01/22/2023]
Abstract
Telomere length (TL) has been associated with several health conditions including cancer. To quantify the effect of TL on outcomes in malignancies and explore the role of type of TL measurement we conducted a librarian-led systematic search of electronic databases identified publications exploring the prognostic role of TL on cancer outcomes. Overall survival (OS) was the primary outcome measure while other time-to-event endpoints were secondary outcomes. Data from studies reporting a hazard ratio (HR) with 95% confidence interval (CI) and/or p-value were pooled in a meta-analysis. HRs were weighted by generic inverse variance and computed by random effects modeling. All statistical tests were two-sided. Sixty-one studies comprising a total of 14,720 patients were included of which 41 (67%) reported OS outcomes. Overall, the pooled HR for OS was 0.88 (95%CI=0.69-1.11, p=0.28). Long (versus short) telomeres were associated with improved outcomes in chronic lymphatic leukemia (CLL) and urothelial cancer (HR=0.45, 95%CI=0.29-0.71 and HR=0.68, 95%CI=0.46-1.00, respectively), conversely worse OS was seen with hepatocellular carcinoma (HR=1.90, 95%CI=1.51-2.38). Pooled HRs (95% CI) for progression-free survival, relapse/disease-free survival, cancer-specific survival, and treatment-free survival were 0.56 (0.41-0.76), 0.76 (0.53-1.10), 0.72 (0.48-1.10), and 0.48 (0.39-0.60), respectively. There was substantial heterogeneity of tissues and methods used for TL measurement and no clear association between TL and outcome was identified in subgroups. In conclusion, there is inconsistent effect of TL on cancer outcomes possibly due to variable methods of measurement. Standardization of measurement and reporting of TL is warranted before the prognostic value of TL can be accurately assessed.
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Affiliation(s)
- Roman Adam
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Laura Díez-González
- Traslational Research laboratory, Albacete University Hospital, and Regional Biomedical Research Center, Castilla La Mancha University, Albacete, Spain
| | - Alberto Ocaña
- Traslational Research laboratory, Albacete University Hospital, and Regional Biomedical Research Center, Castilla La Mancha University, Albacete, Spain
| | - Boštjan Šeruga
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Eitan Amir
- Divisions of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Department of Medicine, University of Toronto, Toronto, Canada
| | - Arnoud J Templeton
- Faculty of Medicine, University of Basel, Basel, Switzerland; Department of Medical Oncology and Hematology, St. Claraspital, Basel, Switzerland.
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