Survival and prognostic factors in chronic lymphocytic leukemia

Bevezetés: Az utóbbi években felfedezett számos új prognosztikai faktor segítséget nyújthat a várható túlélés meghatározásához krónikus lymphocytás leukémia esetében. Célok: Jelen tanulmány célja e prognosztikai faktorok gyakoriságának, valamint egymással való összefüggésének meghatározása volt 419 beteg mintáin. Módszerek: 160 esetben végezték el az immunglobulin-nehézláncgén mutációs vizsgálatát. Eredmények: Az esetek 62%-ában nem mutált immunglobulin gént találtak, a nehézlánc géncsaládok használata különbözött a mutációs státusz függvényében. A CD38 expresszió 78%-os konkordanciát mutatott a mutációs státusszal, a ZAP-70-expresszió tekintetében korrelációt nem figyeltek meg. Citogenetikai abnormalitást 76%-ban láttak, a leggyakoribb eltérések a del(13q) (57%), a 12-es triszómia (15%), a del(11q) (12%) és a del(17p) (6%) voltak. A del(11q)-t hordozó esetek 95%-a nem mutált, az egyedül del(13q)-t hordozó esetek 74%-a mutált IgH-gént tartalmazott. Következtetések: A vizsgált paraméterek nem függetlenek egymástól, ezért alkalmazásuk a klinikai gyakorlatban gondos tervezést igényel.

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Multivariable Model for Time to First Treatment in Patients With Chronic Lymphocytic Leukemia

Journal of Clinical Oncology ◽

10.1200/jco.2010.33.9002 ◽

2011 ◽

Vol 29 (31) ◽

pp. 4088-4095 ◽

Cited By ~ 85

Author(s):

William G. Wierda ◽

Susan O'Brien ◽

Xuemei Wang ◽

Stefan Faderl ◽

Alessandra Ferrajoli ◽

...

Keyword(s):

Prognostic Factors ◽

Chronic Lymphocytic Leukemia ◽

Multivariable Analysis ◽

Lymphocytic Leukemia ◽

Cancer Center ◽

Serum Lactate Dehydrogenase ◽

Multivariable Model ◽

Cervical Lymph Nodes ◽

Mutation Status ◽

Time To First Treatment

Purpose The clinical course for patients with chronic lymphocytic leukemia (CLL) is diverse; some patients have indolent disease, never needing treatment, whereas others have aggressive disease requiring early treatment. We continue to use criteria for active disease to initiate therapy. Multivariable analysis was performed to identify prognostic factors independently associated with time to first treatment for patients with CLL. Patients and Methods Traditional laboratory, clinical prognostic, and newer prognostic factors such as fluorescent in situ hybridization (FISH), IGHV mutation status, and ZAP-70 expression evaluated at first patient visit to MD Anderson Cancer Center were correlated by multivariable analysis with time to first treatment. This multivariable model was used to develop a nomogram—a weighted tool to calculate 2- and 4-year probability of treatment and estimate median time to first treatment. Results There were 930 previously untreated patients who had traditional and new prognostic factors evaluated; they did not have active CLL requiring initiation of treatment within 3 months of first visit and were observed for time to first treatment. The following were independently associated with shorter time to first treatment: three involved lymph node sites, increased size of cervical lymph nodes, presence of 17p deletion or 11q deletion by FISH, increased serum lactate dehydrogenase, and unmutated IGHV mutation status. Conclusion We developed a multivariable model that incorporates traditional and newer prognostic factors to identify patients at high risk for progression to treatment. This model may be useful to identify patients for early interventional trials.

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Prognostic factors in chronic lymphocytic leukemia

Current Hematologic Malignancy Reports ◽

10.1007/s11899-007-0007-1 ◽

2007 ◽

Vol 2 (1) ◽

pp. 49-55 ◽

Cited By ~ 10

Author(s):

Neil E. Kay ◽

Tait D. Shanafelt

Keyword(s):

Prognostic Factors ◽

Chronic Lymphocytic Leukemia ◽

Lymphocytic Leukemia

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Combination chemoimmunotherapy with pentostatin, cyclophosphamide, and rituximab shows significant clinical activity with low accompanying toxicity in previously untreated B chronic lymphocytic leukemia

Blood ◽

10.1182/blood-2006-07-033274 ◽

2006 ◽

Vol 109 (2) ◽

pp. 405-411 ◽

Cited By ~ 229

Author(s):

Neil E. Kay ◽

Susan M. Geyer ◽

Timothy G. Call ◽

Tait D. Shanafelt ◽

Clive S. Zent ◽

...

Keyword(s):

Prognostic Factors ◽

Chronic Lymphocytic Leukemia ◽

Minimal Residual Disease ◽

Residual Disease ◽

Lymphocytic Leukemia ◽

Clinical Activity ◽

Hematologic Toxicity ◽

Color Flow ◽

Significant Clinical Activity ◽

Minimal Residual

Abstract Building on the prior work of use of pentostatin in chronic lymphocytic leukemia (CLL), we initiated a trial of combined pentostatin (2 mg/m2), cyclophosphamide (600 mg/m2), and rituximab (375 mg/m2) for 65 symptomatic, previously untreated patients. Of 64 evaluable patients, 34 (53%) were high Rai risk, 71% were nonmutated for the immunoglobulin heavy-chain variable region gene, 34% were CD38+, and 34% were ZAP-70+. Thirty patients (52%) had one anomaly detected by fluorescence in situ (FISH) hybridization, and 21 (36%) had complex FISH defects. Thirty-eight patients (58%) had grade 3+ hematologic toxicity but minimal transfusion needs and no major infections. Responses occurred in 58 patients (91%), with 26 (41%) complete responses (CRs), 14 (22%) nodular partial responses (nodular PRs), and 18 (28%) partial responses (PRs). Many patients with a CR also lacked evidence of minimal residual disease by 2-color flow cytometry. Examination of prognostic factors demonstrated poor response in the 3 patients with del(17p). In contrast, we found this regimen was equally effective in young versus older (> 70 years) patients and in del(11q22.3) versus other favorable prognostic factors. Thus, this novel regimen of pentostatin, cyclophosphamide, and rituximab for previously untreated patients with CLL demonstrated significant clinical activity despite poor risk-based prognoses, achievement of minimal residual disease in some, and modest toxicity.

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