haematology
Contributions
Type: Publication Only
Background
Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with variable outcome. The identification of factors that could predict the clinical course of CLL is a crucial objective. Recently, prognostic models involving a set of clinical and biological risk factors have been proposed to evaluate the association with the time before initiating treatment and the prognosis for patients with CLL.
Aims
In our study we investigated time to first treatment (TFT), measured as the time elapsed between diagnosis and first treatment, and its relation with clinical and biological parameters and overall survival.
Methods
We retrospectively evaluated patients (pts) with de novo CLL treated at the University Hospital of Bari (Italy) between April 2006 and February 2013. At diagnosis pts were studied for clinical characteristics and biological prognostic factors: age, β-2 microglobulin, absolute lymphocyte count, sex, Rai stage, number of lymph node groups involved, pattern of bone marrow involvement, splenomegaly, mutational status of the immunoglobulin heavy chain gene variable region (IGVH), cytogenetic abnormalities detected by FISH. Median time to first treatment was calculated for all pts, divided into two groups according to Median time to first treatment. The first group included pts treated within 40 months from diagnosis; the second group pts treated after 40 months from diagnosis. Univariate analyses of each group were performed to evaluate the correlation between the clinical variables and time to treatment. In addition, overall survival was calculated and compared in the two groups.
Results
In total, 69 pts were included; 42 in the group of pts treated within 40 months from diagnosis, and 27 in the group treated after 40 months.
Statistically significant differences were seen between the 2 groups regarding the pattern of bone marrow involvement (diffuse versus other patterns of marrow involvement; P = 0.05), number of lymph node groups involved, (one versus more than one; P = 0.01); mutational status of the immunoglobulin heavy chain gene variable region (IGVH) (mutated versus unmutated; P =0.05), cytogenetic abnormalities by FISH (21 pts with 13q14 in the group of TFT >40 months and 2 in the group of TFT <40 months; P:0.01). No statistically significant difference was seen among the other clinical variables and TFT. Moreover, comparing the OS of the group with TFT >40 months with OS of the group with TFT <40 months, statistically significant difference was observed (P:0.01).
Summary
In our study the pattern of bone marrow involvement, the number of lymph node groups involved, the mutational status of the immunoglobulin heavy chain gene variable region and the cytogenetic abnormalities could help to recognize at diagnosis a subset of patients that may show rapid evolution to progressive disease. Multicentric studies and larger cohorts of patients are warranted to confirm these preliminary data.
Keyword(s): Chronic lymphocytic leukemia, Prognosis
Type: Publication Only
Background
Chronic lymphocytic leukemia (CLL) is a heterogeneous disease with variable outcome. The identification of factors that could predict the clinical course of CLL is a crucial objective. Recently, prognostic models involving a set of clinical and biological risk factors have been proposed to evaluate the association with the time before initiating treatment and the prognosis for patients with CLL.
Aims
In our study we investigated time to first treatment (TFT), measured as the time elapsed between diagnosis and first treatment, and its relation with clinical and biological parameters and overall survival.
Methods
We retrospectively evaluated patients (pts) with de novo CLL treated at the University Hospital of Bari (Italy) between April 2006 and February 2013. At diagnosis pts were studied for clinical characteristics and biological prognostic factors: age, β-2 microglobulin, absolute lymphocyte count, sex, Rai stage, number of lymph node groups involved, pattern of bone marrow involvement, splenomegaly, mutational status of the immunoglobulin heavy chain gene variable region (IGVH), cytogenetic abnormalities detected by FISH. Median time to first treatment was calculated for all pts, divided into two groups according to Median time to first treatment. The first group included pts treated within 40 months from diagnosis; the second group pts treated after 40 months from diagnosis. Univariate analyses of each group were performed to evaluate the correlation between the clinical variables and time to treatment. In addition, overall survival was calculated and compared in the two groups.
Results
In total, 69 pts were included; 42 in the group of pts treated within 40 months from diagnosis, and 27 in the group treated after 40 months.
Statistically significant differences were seen between the 2 groups regarding the pattern of bone marrow involvement (diffuse versus other patterns of marrow involvement; P = 0.05), number of lymph node groups involved, (one versus more than one; P = 0.01); mutational status of the immunoglobulin heavy chain gene variable region (IGVH) (mutated versus unmutated; P =0.05), cytogenetic abnormalities by FISH (21 pts with 13q14 in the group of TFT >40 months and 2 in the group of TFT <40 months; P:0.01). No statistically significant difference was seen among the other clinical variables and TFT. Moreover, comparing the OS of the group with TFT >40 months with OS of the group with TFT <40 months, statistically significant difference was observed (P:0.01).
Summary
In our study the pattern of bone marrow involvement, the number of lymph node groups involved, the mutational status of the immunoglobulin heavy chain gene variable region and the cytogenetic abnormalities could help to recognize at diagnosis a subset of patients that may show rapid evolution to progressive disease. Multicentric studies and larger cohorts of patients are warranted to confirm these preliminary data.
Keyword(s): Chronic lymphocytic leukemia, Prognosis