Chronic lymphocytic leukemia (CLL) is the most frequent lymphoproliferative syndrome in
western countries. CLL evolution is frequently indolent, and treatment is mostly reserved
for those patients with signs or symptoms of disease progression. In this work, we used
RNA sequencing data from the International Cancer Genome Consortium CLL cohort
to determine new gene expression patterns that correlate with clinical evolution.We
determined that a 290-gene expression signature, in addition to immunoglobulin heavy
chain variable region (IGHV) mutation status, stratifies patients into four groups with
notably different time to first treatment. This finding was confirmed in an independent
cohort. Similarly, we present a machine learning algorithm that predicts the need for
treatment within the first 5 years following diagnosis using expression data from 2,198
genes. This predictor achieved 90% precision and 89% accuracy when classifying
independent CLL cases. Our findings indicate that CLL progression risk largely correlates
with particular transcriptomic patterns and paves the way for the identification of high-risk
patients who might benefit from prompt therapy following diagnosis.S