Logo: to the web site of Uppsala University

uu.sePublications from Uppsala University
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Isolated subclonal mutations are not a common feature in untreated chronic lymphocytic leukemia
Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.ORCID iD: 0000-0003-0898-4940
Uppsala University, Science for Life Laboratory, SciLifeLab.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology.ORCID iD: 0000-0003-2468-0226
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Haematology. Uppsala University, Science for Life Laboratory, SciLifeLab.ORCID iD: 0000-0002-9510-8801
Show others and affiliations
(English)Manuscript (preprint) (Other academic)
National Category
Hematology
Research subject
Medical Science; Medical Science
Identifiers
URN: urn:nbn:se:uu:diva-498335OAI: oai:DiVA.org:uu-498335DiVA, id: diva2:1743396
Funder
Insamlingsstiftelsen Lions Cancerforskningsfond Mellansverige Uppsala-ÖrebroAvailable from: 2023-03-15 Created: 2023-03-15 Last updated: 2023-03-23
In thesis
1. Chronic lymphocytic leukemia: Studies on cardiovascular disease, biomarkers and subclones
Open this publication in new window or tab >>Chronic lymphocytic leukemia: Studies on cardiovascular disease, biomarkers and subclones
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The treatment of Chronic lymphocytic leukemia (CLL) is rapidly changing, with targeted therapies, e.g. Bruton’s tyrosine kinase inhibitors (BTKi), entering the frontline and relapse setting. However, BTKis have significant adverse effects, most notably cardiovascular disease (CVD). This is of particular concern since the CLL population consists of mainly elderly patients. Data on CVD comorbidity and its possible relation to inflammation in real-world CLL patients is scarce. The aim of this thesis was to study inflammatory biomarkers, the epidemiology of CVD in CLL as well as the occurrence of subclones, in population-based cohorts. In paper I we analyzed the plasma/serum concentrations in of 11 biomarkers with known association to inflammation and/or CVD in 139 patients with CLL and 71 healthy age- and sex-matched controls. Eight out of 11 biomarkers were increased among CLL patients compared to controls. In addition, the pattern of biomarker expression differed between patients and controls. In paper II, we demonstrated that 32% of all patients diagnosed with CLL in Sweden during 2007-2010 had ≥1 CVD <10 years prior to CLL diagnosis which increased to 37% at start of primary therapy. In paper III, a large CLL cohort, n=4261, was studied (all patients diagnosed with CLL during 2007-2015) with the addition of 5 comparators per CLL patient. In line with paper II, a substantial burden of CVD at time of diagnosis was observed, 39% vs 41% among comparators (p<0.05). During follow-up, the incidence of CVD was increased among patients with CLL (HR 1.69, 1.61-1.77) compared to comparators, regardless of previous CVD or need of therapy. All-cause mortality (HR 2.29, 2.14-2.14) but not CVD mortality (HR 1.00, 0.89-1.13) was increased among patients with CLL vs comparators. Finally, approximately 50% of patients with CLL were prescribed antihypertensive drugs. In paper IV, we studied the occurrence of subclones down to a variant allele frequency (VAF) of 1% using a deep-sequencing NGS panel covering 15 recurrently mutated genes in pretreatment samples from 40 patients with CLL. We found that 48% (n=19/40) exhibited clonal mutations (VAF≥10%,) while 25% (n=10/40) had subclonal mutations (VAF<10%). In 6 out of these 10 patients, subclonal and clonal mutations co-occurred revealing that isolated subclonal mutations were not a frequent event. Mutations were significantly enriched in patients requiring therapy (p<0.05). In conclusion, CLL patients have increased blood concentrations of biomarkers associated with low-grade inflammation. However, they do not have an increased risk of CVD at the time of CLL diagnosis. Nonetheless, an increase in CVD during follow-up was observed, the cause of which is currently unknown. Importantly, the CVD burden in CLL is substantial in our population-based studies and of concern in the era of increasing BTKi usage. Finally, subclonal mutations are present among 25% of CLL patients and commonly co-exists with clonal mutations. The prognostic role of these subclonal mutations needs further investigation.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2023. p. 74
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1930
Keywords
: Chronic lymphocytic leukemia, cardiovascular disease, population-based, biomarkers, subclones
National Category
Hematology
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-498525 (URN)978-91-513-1771-7 (ISBN)
Public defence
2023-05-17, H:son Holmdahlsalen, Ing 100 Akademiska sjukhuset, Uppsala, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2023-04-25 Created: 2023-03-23 Last updated: 2023-04-25

Open Access in DiVA

No full text in DiVA

Authority records

Larsson, KarinYoung, EmmaHöglund, MartinMattsson, MattiasMansouri, Larry

Search in DiVA

By author/editor
Larsson, KarinYoung, EmmaHöglund, MartinMattsson, MattiasMansouri, Larry
By organisation
Science for Life Laboratory, SciLifeLabDepartment of Immunology, Genetics and PathologyHaematology
Hematology

Search outside of DiVA

GoogleGoogle Scholar

urn-nbn

Altmetric score

urn-nbn
Total: 40 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf