scholarly journals Comparative analysis of international prognostic index for chronic lymphocytic leukemia, progression-risk score, and MD Anderson Cancer Center 2011 score - a single center experience

2021 ◽  
pp. 47-47
Author(s):  
Biljana Mihaljevic ◽  
Vojin Vukovic ◽  
Natasa Milic ◽  
Teodora Karan-Djurasevic ◽  
Natasa Tosic ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Risk Score ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Lymphocytic Leukemia ◽  
Prognostic Models ◽  
Risk Scores ◽  
Cancer Center ◽  
Progression Risk ◽  
Md Anderson

Introduction/Objective. Prognostication of chronic lymphocytic leukemia (CLL) has been substantially improved in recent times. Among several prognostic models (PMs) focused on the prediction of time to first treatment (TTFT), Progression-Risk Score (PRS) and MD Anderson Cancer Center score 2011 (MDACC 2011) are the most relevant, while CLL-International Prognostic Index (CLL-IPI), although originally developed to predict overall survival (OS), is also being used to estimate TTFT. The aim of this study was to investigate CLL-IPI, PRS, and MDACC 2011 prognostic values regarding TTFT and OS. Methods. The analyzed cohort included 57 unselected Serbian CLL patients from a single institution, with the basic characteristics reflecting more aggressive disease than in general de novo CLL population. The eligible patients were assigned with investigated PMs, and TTFT and OS analyses were performed. Results. Patients with higher risk scores according to CLL-IPI, PRS, and MDACC 2011 underwent treatment significantly earlier than patients with lower risk scores (p = 0.002, p = 0.019, and p<0.001, respectively). In multivariate analysis, MDACC 2011 and CLL-IPI retained their significance regarding TTFT (p = 0.001 and p = 0.018, respectively), while PRS did not. CLL-IPI was the only significant predictor of OS both at the univariate (p = 0.005) and multivariate (p = 0.013) levels. Conclusion. CLL-IPI, PRS, and particularly MDACC 2011 are able to predict TTFT even in cohorts with more advanced-disease patients, while for prediction of OS, CLL-IPI is the only applicable among the three PMs. These results imply that prognostic models should be investigated in more diverse CLL populations, as it is in real-life setting.

scholarly journals The International Prognostic Index for Patients with Chronic Lymphocytic Leukemia Has the Higher Value in Predicting Overall Outcome Compared with the Barcelona-Brno Biomarkers Only Prognostic Model and the MD Anderson Cancer Center Prognostic Index

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Carolina Muñoz-Novas ◽  
María Poza-Santaella ◽  
Isabel González-Gascón y Marín ◽  
María Hernández-Sánchez ◽  
Ana-Eugenia Rodríguez-Vicente ◽  
...  
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Prognostic Model ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Lymphocytic Leukemia ◽  
Cancer Center ◽  
Higher Power ◽  
Md Anderson ◽  
The One

In recent years, new prognostic indexes (PIs) for chronic lymphocytic leukemia (CLL), which include clinical, biological, and genetic variables, have been validated, highlighting the MD Anderson Cancer Center prognostic index (MDACC PI), the CLL-international prognostic index (CLL-IPI), and the Barcelona-Brno biomarkers only prognostic model. The aim of this study is to compare the utility of these PIs in a cohort of Spanish patients. A retrospective analysis of 696 unselected CLL patients newly diagnosed and previously untreated from different Spanish institutions was performed. The MDACC PI, the CLL-IPI, and the biomarkers only PI were applied to these patients, and a comparison of the three PIs was performed. With a median follow-up time of 46 months, 394 patients were alive and 187 had received treatment. The median overall survival (OS) was 173 months and the median time to first therapy (TTFT) was 32 months. Significant differences were obtained in OS and TTFT for all subgroups when applying these PIs, with the CLL-IPI being the one with the higherc-index (0.676 for OS and 0.757 for TTFT). The three PIs were able to discriminate patients in different prognostic subgroups. In our cohort, the CLL-IPI showed higher power in predicting TTFT and OS.

scholarly journals Prognostic impact of prevalent chronic lymphocytic leukemia stereotyped subsets: analysis within prospective clinical trials of the German CLL Study Group (GCLLSG)

Haematologica ◽  
2019 ◽  
Vol 105 (11) ◽  
pp. 2598-2607 ◽  
Author(s):  
Sonia Jaramillo ◽  
Andreas Agathangelidis ◽  
Christof Schneider ◽  
Jasmin Bahlo ◽  
Sandra Robrecht ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Chronic Lymphocytic Leukemia ◽  
Early Stage ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Lymphocytic Leukemia ◽  
Phase Iii ◽  
Prognostic Impact ◽  
Advanced Stage ◽  
Multicenter Clinical Trials

Almost one-third of all patients with chronic lymphocytic leukemia (CLL) express stereotyped B cell receptor immunoglobulins (BcR IG) and can be assigned to distinct subsets, each with a particular BcR IG. The largest stereotyped subsets are #1, #2, #4 and #8, associated with specific clinicobiological characteristics and outcomes in retrospective studies. We assessed the associations and prognostic value of these BcR IG in prospective multicenter clinical trials reflective of two different clinical situations: i) early-stage patients (watch-and-wait arm of the CLL1 trial) (n=592); ii) patients in need of treatment, enrolled in 3 phase III trials (CLL8, CLL10, CLL11), treated with different chemo-immunotherapies (n=1861). Subset #1 was associated with del(11q), higher CLL international prognostic index (CLL-IPI) scores and similar clinical course to CLL with unmutated immunoglobulin heavy variable (IGHV) genes (U-CLL) in both early and advanced stage groups. IGHV-mutated (M-CLL) subset #2 cases had shorter time-to-first-treatment (TTFT) versus other M-CLL cases in the early-stage cohort (HR: 4.2, CI: 2-8.6, p<0.001), and shorter time-to-next-treatment (TTNT) in the advanced-stage cohort (HR: 2, CI: 1.2-3.3, p=0.005). M-CLL subset #4 was associated with lower CLL-IPI scores and younger age at diagnosis; in both cohorts, these patients showed a trend towards better outcomes versus other M-CLL. U-CLL subset #8 was associated with trisomy 12. Overall, this study shows that major stereotyped subsets have distinctive characteristics. For the first time in prospective multicenter clinical trials, subset # 2 appeared as an independent prognostic factor for earlier TTFT and TTNT and should be proposed for risk stratification of patients.

External Validation On Biological Basis of New Prognostic Index in Early Asymptomatic Chronic Lymphocytic Leukemia (CLL) Patients: The Gruppo Italiano Studio Linfomi (GISL) Experience.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2375-2375
Author(s):  
Stefano Molica ◽  
Sonia Fabris ◽  
Giovanna Cutrona ◽  
Massimo Gentile ◽  
Emanuela Anna Pesce ◽  
...  
Keyword(s):  
High Risk ◽  
Chronic Lymphocytic Leukemia ◽  
Risk Score ◽  
Prognostic Index ◽  
Lymphocytic Leukemia ◽  
Low Risk ◽  
Biological Parameters ◽  
Cytogenetic Abnormalities ◽  
Prognostic Relevance ◽  
Binet Stage

Abstract Abstract 2375 Poster Board II-352 A prognostic index based on widely available clinical and laboratory features was recently proposed to predict survival in patients with previously untreated patients with chronic lymphocytic leukemia (CLL) by MD Anderson investigators. However, whether proposed clinical risk categories may surrogate new biological variables of prognostic relevance (i.e., mutational status of the IgVH gene regions, ZAP-70 or CD-38 expression, cytogenetic abnormalities) is unclear thus far. In a series of 160 asymptomatic Binet stage A patients enrolled in a Gruppo Italiano Studio Linfomi (GISL) multicentre trial designed to validate prospectively biological parameters in early CLL as well as to assess the impact on clinical outcome of an early versus delayed policy of treatment with subcutaneous alemtuzumab in the high biological risk, we evaluated whether clinical categories derived from newly proposed prognostic index reflected biological risk. Since the original prognostic index was derived from a database including cases with more advanced disease we used an optimal cutoff search to determine how to best split Binet stage A patients in different prognostic groups. To this purpose an independent patient cohort consisting of 310 Binet stage A patients included in a GIMEMA (Gruppo Italiano Malattie EMatologiche Maligne dell'Adulto) database was used. According to recursive partitioning (RPART) model, a classification tree was built that identified two subsets of patients who scored respectively: 0-3 (low risk) and 4-7 (high risk). Therefore, by prognostic index, 48.7% and 51.2% of 160 asymptomatic stage A patients, respectively, met criteria of low risk and high risk disease. In our prospective series high- risk score was more frequently associated with both unmutated IgVH status (P=0.009) and higher CD38-expression (P=0.002); in contrast only a trend towards an increased ZAP-70 expression could be found (P=0.06). As far as cytogenetic abnormalities are concerned, we observed that 11q deletion occurred more frequently among patients belonging to high-risk score (P=0.005), while cases with 13q deletion or trisomy 12 were homogeneously distributed among low- and high-risk patient category(P=0.151 and P=0.452, respectively). We did not consider suitable for correlation analysis 17p deletion since observed only in 2 out of 160 Binet stage A patients. In conclusion, our results demonstrate in a prospective cohort of patients with early CLL that clinical categories of a revised score index may surrogate biological parameters of prognostic relevance. The observation reinforces the revised IWCLL guidelines recommendations to assess the risk of CLL patients on clinical basis and to deserve biological studies to patients eligible for clinical trials. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Chronic lymphocytic leukemia international prognostic index: a systematic review and meta-analysis

Blood ◽  
2018 ◽  
Vol 131 (3) ◽  
pp. 365-368 ◽  
Author(s):  
Stefano Molica ◽  
Diana Giannarelli ◽  
Rosanna Mirabelli ◽  
Luciano Levato ◽  
Neil E. Kay ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Lymphocytic Leukemia ◽  
Meta Analysis ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Lymphocytic Leukemia

Predicting Clinical Outcome in B-Chronic Lymphocytic Leukemia

2012 ◽  
pp. 394-398
Author(s):  
Neil E. Kay
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
B Cell ◽  
Early Stage ◽  
Response To Therapy ◽  
Lymphocytic Leukemia ◽  
Prognostic Models ◽  
B Cell Malignancy ◽  
Duration Of Response ◽  
Current Therapies ◽  
Progression Risk

Overview: B-Chronic lymphocytic leukemia (CLL) is a relatively common B-cell malignancy that has a very heterogeneous clinical course, despite carrying the designation of “chronic,” which is a gross oversimplification. Being able to give some estimate of the rates of disease progression and overall survival (OS) at first diagnosis is, therefore, important in CLL. The ability to accurately predict response to therapy, as well as subsequent duration of response to therapy, is required given the variability of current therapies to induce and sustain treatment responses. The holy grail of prognostics would be to state with accuracy which therapy or types of therapy are best for a given patient. Although there is no complete answer to prognostic counseling, there is a continued development of markers specific to the CLL B cell and/or to its environment, as well as of testing of prognostic models. These models use both traditional and novel prognostic markers that can aid in the dissection of outcome for early-stage CLL in terms of progression risk and time to therapy. This has resulted in significant enhancement of our ability to guide and predict outcome for our patients with CLL.

scholarly journals Prognostication of chronic lymphocytic leukemia in the era of new agents

Hematology ◽  
2016 ◽  
Vol 2016 (1) ◽  
pp. 149-155 ◽  
Author(s):  
Barbara Eichhorst ◽  
Michael Hallek
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
Lymphocytic Leukemia ◽  
Prognostic Scores ◽  
Clinical Staging ◽  
Free Survival ◽  
Staging Systems ◽  
The Individual ◽  
Modern Era

Abstract The prognosis of chronic lymphocytic leukemia (CLL) is very heterogeneous. Therefore, a plethora of prognostic factors has been identified to allow a better prediction of the individual prognosis of a given patient. The clinical staging systems by Rai and Binet have been the backbone of clinical management for several decades. The advent of genetic and biochemical markers, as well as next-generation sequencing has provided several markers that can predict the prognosis of patients with CLL. Using this knowledge, several scores have been created to improve predicting overall survival and/or treatment-free survival. These prognostic scores were developed in the era of chemotherpay/chemoimmunotherapy. Therefore, they now need to be tested with novel agents. However, despite tremendously improved therapeutic options, CLL patients with TP53 dysfunction or a complex karyotype remain at very high risk and seem to have a shorter (treatment-free) survival. The recently published international prognostic index (CLL IPI) incorporates most of these factors and provides a tool to analyze outcome in the modern era of targeted therapies.

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