Prognosis Assessment of Early-Stage Chronic Lymphocytic Leukemia: Are We Ready to Predict Clinical Evolution Without a Crystal Ball?

The discovery of new biologic variables with high prognostic effect has been accompanied by the emergence of different prognostic indexes (PIs) to assess the time to first treatment in patients with early-stage (Binet A) chronic lymphocytic leukemia (CLL). The present study compared the prognostic v...

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Published in:Clinical lymphoma, myeloma and leukemia myeloma and leukemia, 2020-08, Vol.20 (8), p.548-555.e4
Main Authors: González-Gascón-y-Marín, Isabel, Muñoz-Novas, Carolina, Figueroa, Iñigo, Hernández-Sánchez, María, Rodríguez-Vicente, Ana-Eugenia, Quijada-Álamo, Miguel, Pérez-Carretero, Claudia, Moreno, Carol, Collado, Rosa, Espinet, Blanca, Puiggros, Anna, Heras, Natalia de las, Bosch, Francesc, Hernández, José-Ángel
Format: Article
Language:English
Subjects:
Barcelona-Brno
CLL-01
CLL-IPI
IPS-A
Tailored approach
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Summary:The discovery of new biologic variables with high prognostic effect has been accompanied by the emergence of different prognostic indexes (PIs) to assess the time to first treatment in patients with early-stage (Binet A) chronic lymphocytic leukemia (CLL). The present study compared the prognostic value of 5 PIs: CLL international prognostic index (CLL-IPI), Barcelona-Brno, international prognostic score-A (IPS-A), CLL-01, and a tailored approach. We applied the 5 PIs to a cohort of 428 unselected patients with Binet A CLL from a multicenter Spanish database with clinical and biologic information available. The predictive value of the scores was assessed using Harrell’s concordance index (C index) and area under the receiver operating characteristic curve (AUC). We found a significant association between time to first treatment and risk subgroups for all 5 PIs used. The most accurate PI was the IPS-A (C-index, 0.72; AUC, 0.76), closely followed by CLL-01 (C-index, 0.69; AUC, 0.70), CLL-IPI (C-index, 0.69; AUC, 0.69), Barcelona-Brno (C-index, 0.67; AUC, 0.69), and the tailored approach (C-index, 0.61 and 0.58; AUC, 0.58 and 0.54). The concordance between the PIs was low (44%), suggesting that although all these PIs improve clinical staging and help physicians in routine clinical practice, it will be necessary to harmonize larger cohorts of patients to define the best PI for treatment decision-making in the real world. Five different prognostic indexes were compared in a cohort of 428 patients with Binet A chronic lymphocytic leukemia (CLL). The most accurate score in predicting the time to first therapy was the International Prognostic Score-A, followed by CLL-01 and CLL international prognostic index. None of the scores was able to predict with total precision the clinical evolution and, therefore, guide therapy decisions.
ISSN:2152-2650
2152-2669
DOI:10.1016/j.clml.2020.03.003