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4621 Comparison of Familial Versus Sporadic Forms of Chronic Lymphocytic Leukemia: An Italian Multicenter Case-Control Study

Program: Oral and Poster Abstracts
Session: 642. Chronic Lymphocytic Leukemia: Clinical and Epidemiological: Poster III
Hematology Disease Topics & Pathways:
Lymphoid Leukemias, Research, CLL, Clinical Research, Diseases, Real-world evidence, Lymphoid Malignancies, Human, Pathogenesis
Monday, December 9, 2024, 6:00 PM-8:00 PM

Alberto Fresa, MD1,2*, Idanna Innocenti, MD, PhD3*, Annamaria Tomasso, MD4*, Candida Vitale, MD, PhD5*, Alessandro Sanna, MD6*, Anna Maria Frustaci, MD7*, Andrea Visentin, MD, PhD8*, Azzurra Anna Romeo, MD9*, Paolo Sportoletti10*, Annamaria Giordano, MD11*, Francesca Perutelli, MD5*, Roberta Murru, MD12*, Francesca Romana Mauro, MD13*, Antonio Mosca, MD14*, Francesca Morelli, MD15*, Roberta Laureana, MD16*, Andrea Galitzia, MD17*, Ilaria Angeletti, MD18*, Esmeralda Conte, MD19*, Riccardo Moia, MD20*, Giovanni Francesco D'Arena, MD21*, Raffaella Pasquale, MD22*, Francesco Autore, MD, PhD23*, Jacopo Olivieri, MD22*, Luca Stirparo, MD14*, Giulia Benintende, MD24*, Andrea Corbingi, MD9*, Maria Ilaria Del Principe16*, Diana Giannarelli, PhD25*, Alessandra Tedeschi, MD7*, Marta Coscia, MD, PhD26,27*, Eugenio Sangiorgi, MD, PhD28*, Dimitar G Efremov, MD, PhD29 and Luca Laurenti, MD14,30*

1Hematology-Oncology and Stem-Cell Transplantation Unit, Department of Onco-Hematology and Innovative Diagnostics, Istituto Nazionale Tumori IRCCS - Fondazione "G. Pascale", Naples, Italy
22. Hematology Section, Deparment of Radiological and Hematological Sciences, Catholic University of Sacred Heart, Rome, Italy
3Department of Laboratory and Haematological Sciences, Haematology Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of Sacred Heart, Roma, Italy
4Catholic University of Sacred Heart, Hematology Section, Department of Radiological and Hematological Sciences, Rome, Italy
5Department of Molecular Biotechnology and Health Sciences, University of Torino and Division of Hematology, University Hospital (A.O.U.) Città della Salute e della Scienza di Torino, Torino, Italy
6Hematology, Department of Oncology, AOU Careggi, Firenze, Italy
7Department of Hematology, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
8Hematology unit, Department of Medicine, University of Padova, Padova, Italy
9Hematology and Stem Cell transplantation Unit, S.M. Goretti Hospital, Polo Universitario Pontino, "Sapienza”, Latina, Italy
10Department of Medicine and Surgery, Institute of Hematology, Centro di Ricerca Emato Oncologica (CREO), University of Perugia, Perugia, Italy
11Unit of Hematology and Stem Cell Transplantation, AOUC Policlinico,  and Department of Precision and Regenerative Medicine and  Ionian Area, "Aldo Moro" University School of Medicine, Bari, Italy, Bari, Italy
12Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS "G. Brotzu", Cagliari, Italy
13Hematology, Department of Translational and Precision Medicine, Sapienza University, Roma, Italy
14Hematology Section, Department of Radiological and Hematological Sciences, Catholic University of Sacred Heart, Rome, Italy
15Department of Hematology, University of Florence, Firenze, Italy
16Hematology, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
17Hematology and Stem Cell Transplantation Unit, Ospedale San Francesco, Hematology and Stem Cell Transplantation Unit, Ospedale San Francesco, Nuoro, Italy
18Department of Onco-hematology, Azienda Ospedaliera Santa Maria di Terni, Terni, Italy
19Hematology Unit, Department of Clinical and Molecular Medicine, Sant'Andrea University Hospital, Sapienza University, ROMA, ITA
20Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
21Hematology and Stem Cell Transplantation Unit, IRCCS Centro Di Riferimento Oncologico Della Basilicata, Rionero In Vulture, PZ, ITA
22SOC Clinica Ematologia, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
23Hematology Section, Department of Radiological and Hematological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
24Department of Medicine 5, Haematolgy and Oncology, Friedrich-Alexander-Universitat Erlangen-Nurnberg (FAU), Universitatsklinkum, Erlangen, Germany
25Facility of Epidemiology and Biostatistics, GSTeP, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
26Department of Medicine and Surgery, University of Insubria, Varese, Italy
27Hematology Division, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy
28Genomic Medicine Section, Department of Life Sciences and Public Health, Catholic University of Sacred Heart, Rome, Italy
29Molecular Hematology, International Centre for Genetic Engineering and Biotechnology, Trieste, TS, Italy
30Hematology Section, Department of Radiological and Hematological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy;, Rome, Italy

The incidence of monoclonal B-cell lymphocytosis (MBL) and chronic lymphocytic leukemia (CLL) in relatives of patients with CLL is 13-22% and 5-7% respectively. Studies on MBL have provided evidence of a more aggressive pattern of evolution in patients with a familiar predisposition, even if in a real-life population study, familial CLL showed non-statistically different overall survival (OS) at 10 years. This retrospective and prospective multicenter case-control study aimed to compare the clinical features, molecular biomarkers, and patient outcomes in terms of time to first treatment (TTFT), time to next treatment (TTNT), and OS between familial and sporadic CLL patients.

Adult MBL/CLL patients from 18 Italian centers were included. The observational period was 1987-2021 for retrospective data, and 2022-2024 for prospective data. Familial CLL was defined as the presence of one or more first-degree relatives affected by MBL/CLL. For each patient with familial CLL, two patients with sporadic CLL matched for gender and age within 4 years were enrolled in the control cohort. Time-to-event outcomes were evaluated using the Kaplan-Meier method. TTFT was defined as time from diagnosis to treatment initiation. TTNT was defined as time from treatment initiation to the initiation of subsequent therapy or death.

Of the 480 enrolled patients, 160 had familial CLL, and 320 had sporadic CLL. Age at diagnosis and gender were matching criteria; therefore, for both cases and controls, 53.7% were male and 46.3% were female, and the median age at diagnosis was 63 years for familial CLL (interquartile range, IQR 52-68), 62 for sporadic CLL (IQR 52-69). Patients with familial CLL at diagnosis manifested more frequently with bulky lymph nodes >5 cm than sporadic CLL [7.2% (11/152) vs. 2.8% (8/290), respectively (p=0.027)]. No other clinical differences were detected between the two groups at diagnosis in terms of advanced Rai/Binet stage, splenomegaly, and hypogammaglobulinemia. No differences were either detected with respect to genetic features, such as del17p, del11q, tris12, del13q, TP53, NOTCH1, SF3B1, and BIRC3 mutations, except for IGHV mutational status. The IGHV gene was unmutated in 36.2% (77/213) of the controls versus 55.5% (61/110) of the cases (p<0.001). The median age at first treatment was 65 years in both groups (IQR 55-72) and TTFT was superimposable (median 35 months in both groups). Frontline treatment was required in 55.6% of familial CLL patients and 43.1% of sporadic CLL patients (p=0.001). Second-line treatment was required in 46.1% of familial CLL patients versus 29.6% of sporadic CLL patients (p=0.034). TTNT was shorter for patients with familial CLL [median TTNT of 60 months (95% CI: 42.9-77.1)] than for sporadic CLL [median TTNT of 94 months (95% CI: 43.7-144.3, p=0.030)]. Stratifying the patients by the treatment received, TTNT for familial cases was 33 months (95% CI: 0-70.2) for patients treated with chemotherapy (CT), 52 months (95% CI: 30.0-74.0) with chemoimmunotherapy (CIT), and 65 months with inhibitors; for sporadic controls, TTNT was 67 months (95% CI: 0-158.4) with CT (p=0.86), 94 months (95% CI: 64.7-123.2) with CIT (p=0.018) and median was not reached with inhibitors (p=0.41). OS at 5, 10, 15, and 20 years was 97.9%, 90.6%, 82.0%, and 68.6% for familial cases and 98.2%, 95.8%, 87.3%, and 75.4% for sporadic controls, respectively (p=0.23). Comparing OS through different “eras”, 5-year OS did not differ between cases and controls neither in the “CT era” (1987-2009), in the “CIT era” (2010-2015) and in the “inhibitors era” (2016-2024). Secondary neoplasms occurred in 18.8% (30/160) of familial CLL patients and 15.9% (51/320) of sporadic CLL patients (p=0.44). Richter’s transformation occurred in 2.0% of familial cases and 2.5% of familial controls (p=0.74).

In this multicenter case-control study, patients with familial CLL showed a more aggressive presentation at diagnosis, higher need for treatment, and shorter TTNT after frontline therapy than those with sporadic CLL, especially with CIT, while OS was similar. Whole-exome sequencing analysis to identify possible recurrent gene mutations in these patients is ongoing. Given the similar OS, screening for familial forms of CLL is not recommended, but familiar predisposition should be investigated to provide optimal clinical care for these patients.

Disclosures: Fresa: AstraZeneca, BeiGene, Abbvie: Honoraria. Vitale: AstraZeneca: Honoraria, Other: support for attending meetings; Takeda: Other: support for attending meetings; AbbVie: Honoraria; Johnson & Johnson: Honoraria. Frustaci: AbbVie, BeiGene: Other: Travel, accommodations, expenses; AbbVie, BeiGene, AstraZeneca, Janssen: Consultancy. Visentin: Abbvie: Membership on an entity's Board of Directors or advisory committees, Research Funding; Beigene: Consultancy, Research Funding, Speakers Bureau; J&J: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Takeda: Membership on an entity's Board of Directors or advisory committees; AstraZenca SpA: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau. Sportoletti: Janssen; AstraZeneca, Abbvie; BeiGene: Honoraria, Membership on an entity's Board of Directors or advisory committees. Mauro: AstraZenca SpA: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Morelli: BeiGene: Current Employment. Autore: BeiGene, AstraZeneca, AbbVie, Janssen: Honoraria. Tedeschi: AstraZeneca, AbbVie, BeiGene, Janssen, Lilly: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau. Coscia: AbbVie: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: support for attending meetings; AstraZeneca: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: support for attending meetings; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: support for attending meetings. Laurenti: AstraZeneca, AbbVie: Research Funding; AstraZeneva, AbbVie, Johnson and Johnson, BeiGene, Lilly: Honoraria; AstraZeneca, AbbVie, Johnson and Johnson, BeiGene, Lilly: Membership on an entity's Board of Directors or advisory committees.

*signifies non-member of ASH