Assessment of Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma by Absolute Lymphocyte Counts in 2,126 Patients: 20 Years of Experience at The University of Texas M.D. Anderson Cancer Center

2007 ◽  
Vol 25 (29) ◽  
pp. 4648-4656 ◽  
Author(s):  
Apostolia M. Tsimberidou ◽  
Sijin Wen ◽  
Susan O'Brien ◽  
Peter McLaughlin ◽  
William G. Wierda ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Prognostic Score ◽  
Lymphocytic Leukemia ◽  
Cancer Center ◽  
Small Lymphocytic Lymphoma ◽  
Region Gene ◽  
Cox Models ◽  
Cytogenetic Abnormalities ◽  
University Of Texas ◽  
The University

Purpose Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are currently considered the same entity, but controversy remains over whether CLL and SLL should be treated similarly. We assessed whether characteristics of patients with CLL and SLL differ in ways other than the absolute lymphocyte count (ALC) and evaluated treatment outcomes and prognostic factors. Methods We searched the electronic database for patients with CLL or SLL who presented to The University of Texas M.D. Anderson Cancer Center (Houston, TX) between 1985 and 2005. We reviewed patient records to determine presenting characteristics, treatment, and clinical outcomes. Cox models using training and validation sets of patients and resampling methods were used to develop a model predicting survival. Results Among 2,126 consecutive CLL/SLL patients, 312 (15%) had ALC less than 5 × 109/L. Patients with ALC less than 5 × 109/L had lower rates of cytogenetic abnormalities (P = .0002) and higher rates of CD38-positive results (P = .0002) and had mutated immunoglobulin heavy-chain variable region gene status (P = .034). Rates of response, survival, and failure-free survival (FFS) were not different among ALC groups. Regimens that included rituximab and a nucleoside analog were associated with superior rates of response and FFS compared with other therapies, irrespective of ALC. Deletion 17p or 6q with or without other cytogenetic abnormalities, age at least 60 years, β2-microglobulin at least 2 mg/L, albumin less than 3.5 g/dL, and creatinine at least 1.6 mg/dL were each found to independently predict shorter survival and formed the basis of a scoring system. Conclusion Patients with CLL or SLL can be treated similarly. A new prognostic score is proposed.

scholarly journals Other Malignancies in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

2009 ◽  
Vol 27 (6) ◽  
pp. 904-910 ◽  
Author(s):  
Apostolia-Maria Tsimberidou ◽  
Sijin Wen ◽  
Peter McLaughlin ◽  
Susan O'Brien ◽  
William G. Wierda ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Survival Rates ◽  
Lymphocytic Leukemia ◽  
Cancer Center ◽  
Second Cancer ◽  
Small Lymphocytic Lymphoma ◽  
University Of Texas ◽  
History Of ◽  
Cox Analysis ◽  
The University

Purpose Other malignancies have been reported to occur with increased frequency in chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). The aim of this study was to determine the frequency, outcomes, and factors associated with other cancers in patients with CLL/SLL. Patients and Methods We reviewed the records of consecutive patients with previously untreated CLL/SLL seen at The University of Texas M. D. Anderson Cancer Center from 1985 to 2005. The number of second cancers observed was compared with the number expected from the Surveillance, Epidemiology, and End Results database. Results Among 2,028 patients, 324 (16%) had a history of other cancers and 227 (11.2%) developed other malignancies during the follow-up period. Overall, 625 cancers were observed in 551 patients, including skin (30%), prostate (13%), breast (9%), melanoma (8%), lymphoma (8%), gastrointestinal (9%), lung (6%), and other cancers (17%). The risk of a second cancer was 2.2 times higher than the expected risk. The response rates in patients with and without a history of other cancers were 86% and 92%, respectively (P = .04), and the 5-year survival rates were 70% and 82%, respectively (P < .001). In Cox analysis, independent factors predicting development of new cancers were older age, male sex, and elevated levels of β2-microglobulin, lactate dehydrogenase, and creatinine. In patients who were treated for CLL/SLL, the treatment regimen did not affect the risk of subsequent cancer (P = .49). Conclusion Patients with CLL/SLL have more than twice the risk of developing a second cancer and an increased frequency of certain cancer types. Awareness of risk factors could permit early detection.

Epstein-Barr Virus in Patients with Chronic Lymphocytic Leukemia.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2113-2113
Author(s):  
Apostolia-Maria Tsimberidou ◽  
Michael J. Keating ◽  
Carlos Bueso-Ramos ◽  
Razelle Kurzrock
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Epstein Barr Virus ◽  
Lymphocytic Leukemia ◽  
Cancer Center ◽  
University Of Texas ◽  
Barr Virus ◽  
Ebv Infection ◽  
Number Of Patients ◽  
Epstein Barr ◽  
The University

Abstract Purpose: The Epstein-Barr virus (EBV) is implicated in the development of Richter’s transformation in patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). The objective of this study was to assess the incidence and the clinical significance of EBV in patients with CLL/SLL. Patients and Methods: Patients with CLL/SLL who presented at The University of Texas M. D. Anderson Cancer Center over a two-year period, and had available marrow paraffin blocks were studied for evidence of EBV infection using a highly specific in-situ hybridization assay for detection of EBV encoded RNA (EBERs). Results were analyzed in relation to other presenting characteristics and outcome. Results: Thirty-two patients were examined. EBERs were detected in 12 of 32 (38%) CLL/SLL marrows versus 0 of 20 normal marrows (p = 0.002). EBERs were observed in sporadic granulocytes alone or in addition to its presence in lymphocytes in nine of the twelve EBV-positive patients. EBERs were detected less frequently in patients with Rai stage 0-1 disease (20%) compared with Rai stage 2–4 (66%; p=0.008); EBER-positive patients tended to have higher lactate dehydrogenase (LDH) levels (p=0.053). The 10-year survival rate was 22% versus 58% for patients with and without discernible EBERs (log-rank, p=0.08). Figure Figure Conclusions: Evidence of EBV infection was found in 38% of CLL/SLL patients assessed. Despite the small number of patients tested, discernable EBERs were significantly more common in individuals with more advanced Rai stage, and there was a trend toward shorter survival in patients in whom EBV EBERs were discerned. Larger studies are needed to determine the prognostic value and role of EBV infection in patients with CLL/SLL.

A Prognostic Score for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma: Analysis of 2189 Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2783-2783
Author(s):  
Apostolia-Maria Tsimberidou ◽  
Peter McLaughlin ◽  
Susan O’Brien ◽  
Sijin Wen ◽  
William G. Wierda ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Chronic Lymphocytic Leukemia ◽  
Prognostic Score ◽  
Lymphocytic Leukemia ◽  
Testing Time ◽  
Small Lymphocytic Lymphoma ◽  
Β2 Microglobulin ◽  
Risk Of Death ◽  
Genomic Aberrations

Abstract Introduction: The prognosis of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) is heterogeneous. The purpose of this study was to assess factors predicting survival in patients with CLL/SLL. Methods: Characteristics at diagnosis were collected from 2189 patients with CLL/SLL who presented to The University of Texas M. D. Anderson Cancer Center between 1985 and 2005. Univariate and multivariate analyses for survival were performed. Pretreatment parameters that remained independently significant in the multivariate analysis were used to design a model to predict an individual patient’s risk of death: the CLL/SLL score. Results. The median age of patients was 58 years (range, 17–90 years). Overall, 1052 patients required treatment for CLL/SLL and 853 (81%) received fludarabine-based therapy. A multivariate analysis of 23 prognostic factors identified the following to have independent adverse significance for survival: 17p del and 6q del +/− other genomic aberrations (p<0.0001), age > 60 years (p<0.0001), albumin < 3.5 g/dL (p<0.0001), β2-microglobulin ≥ 2 mg/L (p<0.0001), creatinine ≥ 1.6 mg/dL (p<0.0001), hemoglobin <11 g/dL (p=0.001), presence of hepatomegaly (p=0.005), male sex (p=0.006), and absolute lymphocyte count ≥ 30 x 109/L (p=0.004). Other factors, such as IgVH mutation and CD38 or ZAP-70 expression, did not significantly correlate with survival, probably because these data were not available in enough patients and follow-up from the testing time was relatively short. The top five pretreatment parameters that remained independently significant in the multivariate analysis were used to design the CLL/SLL score in 1564 patients who had available data for all five parameters. Since the relative risks associated with each of the top five independently significant risk factors were comparable, the relative risk of death could be determined by summing the number of risk factors present at diagnosis. At 5 years, 96%, 79%, 69%, 30%, and 16% of patients with 0, 1, 2, 3, or 4 (including 1 patient with a score of 5) risk factors, respectively, are expected to be alive [insert Figure here]. Conclusions: A prognostic score to predict survival in patients with CLL/SLL is proposed. The score is based on the five most statistically significant independent factors, i.e., 17p or 6q del +/− other genomic aberrations; age; and levels of β2-microglobulin, albumin, and creatinine. This score may be used to identify specific risk groups, to improve treatment choices and to compare different therapeutic approaches in patients with CLL/SLL. Figure Figure

scholarly journals Minimal Residual Disease in Chronic Lymphocytic Leukemia: Highlights From SOHO 2020

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Lisa Nodzon, PhD, ARNP, AOCNP
Keyword(s):  
Minimal Residual Disease ◽  
Residual Disease ◽  
Lymphocytic Leukemia ◽  
Cancer Center ◽  
Clinical Implications ◽  
University Of Texas ◽  
Key Points ◽  
Md Anderson ◽  
The University ◽  
Minimal Residual

At the 2020 Society of Hematologic Oncology (SOHO) Annual Meeting, William Wierda, MD, PhD, of The University of Texas MD Anderson Cancer Center, described the clinical implications of measuring minimal residual disease. Lisa Nodzon, PhD, ARNP, AOCNP®, of Moffitt Cancer Center, summarizes the key points for advanced practitioners.

Impact of immunoglobulin heavy chain variable region mutational status on the outcome of patients with chronic lymphocytic leukemia harboring isolated 13q deletion.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6608-6608
Author(s):  
Gelenis C. Domingo ◽  
Samir Dalia ◽  
Julio C. Chavez ◽  
Estrella M. Carballido ◽  
Paibel I. Aguayo-Hiraldo ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Demographic Data ◽  
Variable Region ◽  
Lymphocytic Leukemia ◽  
Cancer Center ◽  
Prognostic Information ◽  
Cytogenetic Abnormalities ◽  
Mutational Status ◽  
The Impact ◽  
13Q Deletion

6608 Background: Several prognostic factors can predict the course of chronic lymphocytic leukemia (CLL). Among them, the IGVH mutational status and the presence of cytogenetic abnormalities are the strongest predictors of outcome. Mutated IGVH and deletion 13q independently confer a survival advantage. CLL patients with mutated IGVH in combination with deletion 13q have a better prognosis when compared to their unmutated IGVH counterparts. However, there is limited data on the outcome of patients harboring favorable deletion 13q and the unfavorable unmutated IGVH. This study aimed at identifying patients with these two indicators in order to obtain important prognostic information. Methods: We used the Moffitt Cancer Center Total Cancer Care (TCC) database to find patients with a diagnosis of CLL between January 1993 and December 2009. Individual charts were reviewed for demographic data and CLL cytogenetics, including IGVH mutation status and presence of deletion 13q. We analyzed the impact of having deletion 13q in combination with an unmutated IGVH on the overall survival (OS) for this subset of CLL patients using Kaplan Meier curves with SPSS statistical software. Results: 546 patients were identified during the aforementioned time period with a diagnosis of CLL. Median age was 62.5 years. 144 (26.4%) of these patients had IGVH and cytogenetic analysis available. 53 patients had 13q deletion as their sole genetic abnormality. Patients with unmutated IGVH and positive for deletion 13q were 19/53 (35.8%). Patients with mutated IGVH and positive for deletion 13q were 34/53 (64.2%). Patients with mutated IGVH and positive for deletion 13q had an OS of 17 years. While patients with unmutated IGVH and positive deletion 13q had a lower median OS of 12 years (91.2% vs 78.9%, p=0.05). Hazard ratio for patients with IGVH mutated and positive deletion 13q was 0.4, p=0.05. Conclusions: Mutated IGVH appears to be associated with improved OS in patients with isolated 13q deletion when compared to patients with unmutated IGVH and isolated 13q deletion. Further research is needed to assess these mutations in relation to other cytogenetic abnormalities in CLL.

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