Identifying patients with chronic lymphocytic leukemia without need of treatment: End of endless watch and wait?
Eur J Haematol
; 108(5): 369-378, 2022 May.
Article
em En
| MEDLINE
| ID: mdl-35030282
ABSTRACT
INTRODUCTION:
Early-stage chronic lymphocytic leukemia (CLL) challenges specialized management and follow-up.METHODS:
We developed and validated a prognostic index to identify newly diagnosed patients without need of treatment (CLL-WONT) by a training/validation approach using data on 4708 patients. Composite scores derived from weighted hazards by multivariable analysis defined CLL-WONT risk groups.RESULTS:
Age (>65 years 1 point), Binet stage (B 2 points), lactate dehydrogenase (LDH) (>205 U/L 1 point), absolute lymphocyte count (15-30 × 109 /L 1 point; >30 × 109 /L; 2 points), ß2-microglobulin (>4 mg/L 1 point), IGHV mutation status (unmutated 1 point), and 11q or 17p deletion (1 point) were independently associated with shorter time to first treatment (TTFT). Low-risk patients demonstrated 5-year TTFT of 2% by internal validation, but 7-19% by external validation. Including all patients with complete scores, the 5-year TTFT was 10% for the 756 (39%) CLL-WONT low-risk patients, and the 704 (37%) patients who were both CLL-WONT and CLL-IPI low risk demonstrated even lower 5-year TTFT (8%).CONCLUSION:
We have adopted the CLL-WONT at an institution covering 1 800 000 individuals to allow patients with both low-risk CLL-WONT and CLL-IPI to be managed by primary healthcare providers, thereby prioritizing specialized hematology services for patients in dire need.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Leucemia Linfocítica Crônica de Células B
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Humans
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article