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International prognostic score for asymptomatic early-stage chronic lymphocytic leukemia
- Source :
- Blood
- 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.
- Subjects :
- Male
Oncology
medicine.medical_specialty
Chronic lymphocytic leukemia
Immunology
Biochemistry
Asymptomatic
03 medical and health sciences
0302 clinical medicine
Internal medicine
Biomarkers, Tumor
medicine
Humans
Stage (cooking)
Survival rate
Aged
Retrospective Studies
030304 developmental biology
Clinical Trials as Topic
0303 health sciences
business.industry
a b c
Retrospective cohort study
Cell Biology
Hematology
Nomogram
Prognosis
medicine.disease
Combined Modality Therapy
Leukemia, Lymphocytic, Chronic, B-Cell
3. Good health
Survival Rate
Nomograms
030220 oncology & carcinogenesis
Mutation
Cohort
Disease Progression
Female
medicine.symptom
IGHV@
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 00064971
- Database :
- OpenAIRE
- Journal :
- Blood
- Accession number :
- edsair.doi.dedup.....b02c7a0e25604cea1a76a9993ac5fc4a
- Full Text :
- https://doi.org/10.1182/blood.2019003453