Back to Search Start Over

International prognostic score for asymptomatic early-stage chronic lymphocytic leukemia

Authors :
Condoluci, Adalgisa
Terzi di Bergamo, Lodovico
Langerbeins, Petra
Hoechstetter, Manuela A.
Herling, Carmen D.
De Paoli, Lorenzo
Delgado, Julio
Rabe, Kari G.
Gentile, Massimo
Doubek, Michael
Mauro, Francesca R.
Chiodin, Giorgia
Mattsson, Mattias
Bahlo, Jasmin
Cutrona, Giovanna
Kotaskova, Jana
Deambrogi, Clara
Smedby, Karin E.
Spina, Valeria
Bruscaggin, Alessio
Wu, Wei
Moia, Riccardo
Bianchi, Elena
Gerber, Bernhard
Zucca, Emanuele
Gillessen, Silke
Ghielmini, Michele
Cavalli, Franco
Stussi, Georg
Hess, Mark A.
Baumann, Tycho S.
Neri, Antonino
Ferrarini, Manlio
Rosenquist, Richard
Forconi, Francesco
Foà, Robin
Pospisilova, Sarka
Morabito, Fortunato
Stilgenbauer, Stephan
Döhner, Hartmut
Parikh, Sameer A.
Wierda, William G.
Montserrat, Emili
Gaidano, Gianluca
Hallek, Michael
Rossi, Davide
Source :
Blood; May 2020, Vol. 135 Issue: 21 p1859-1869, 11p
Publication Year :
2020

Abstract

Most patients with chronic lymphocytic leukemia (CLL) are diagnosed with early-stage disease and managed with active surveillance. The individual course of patients with early-stage CLL is heterogeneous, and their probability of needing treatment is hardly anticipated at diagnosis. We aimed at developing an international prognostic score to predict time to first treatment (TTFT) in patients with CLL with early, asymptomatic disease (International Prognostic Score for Early-stage CLL [IPS-E]). Individual patient data from 11 international cohorts of patients with early-stage CLL (n = 4933) were analyzed to build and validate the prognostic score. Three covariates were consistently and independently correlated with TTFT: unmutated immunoglobulin heavy variable gene (IGHV), absolute lymphocyte count higher than 15 × 109/L, and presence of palpable lymph nodes. The IPS-E was the sum of the covariates (1 point each), and separated low-risk (score 0), intermediate-risk (score 1), and high-risk (score 2-3) patients showing a distinct TTFT. The score accuracy was validated in 9 cohorts staged by the Binet system and 1 cohort staged by the Rai system. The C-index was 0.74 in the training series and 0.70 in the aggregate of validation series. By meta-analysis of the training and validation cohorts, the 5-year cumulative risk for treatment start was 8.4%, 28.4%, and 61.2% among low-risk, intermediate-risk, and high-risk patients, respectively. The IPS-E is a simple and robust prognostic model that predicts the likelihood of treatment requirement in patients with early-stage CLL. The IPS-E can be useful in clinical management and in the design of early intervention clinical trials.

Details

Language :
English
ISSN :
00064971 and 15280020
Volume :
135
Issue :
21
Database :
Supplemental Index
Journal :
Blood
Publication Type :
Periodical
Accession number :
ejs55360519
Full Text :
https://doi.org/10.1182/blood.2019003453