Journal article

International prognostic score for asymptomatic early-stage chronic lymphocytic leukemia

  • Condoluci, Adalgisa Institute of Oncology Research (IOR), Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
  • Terzi di Bergamo, Lodovico Institute of Oncology Research (IOR), Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
  • Langerbeins, Petra Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Germany
  • Hoechstetter, Manuela A. Hospital Munich-Schwabing, German CLL Study Group, Munich, Germany
  • Herling, Carmen D. Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Germany
  • De Paoli, Lorenzo Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
  • Delgado, Julio Hospital Clinic, Barcelona, Spain
  • Rabe, Kari G. Mayo Clinic, Rochester, MN, USA
  • Gentile, Massimo Azienda Ospedaliera of Cosenza, Italy
  • Doubek, Michael Interní Hematologická a Onkologická Klinika (IHOK), University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
  • Mauro, Francesca R. Division of Hematology, Sapienza University, Rome, Italy
  • Chiodin, Giorgia Cancer Sciences Division, University of Southampton, United Kingdom
  • Mattsson, Mattias Uppsala University Hospital, Sweden
  • Bahlo, Jasmin Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Germany
  • Cutrona, Giovanna IRCCS Ospedale Policlinico San Martino, Genoa, Italy
  • Kotaskova, Jana Interní Hematologická a Onkologická Klinika (IHOK), University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
  • Deambrogi, Clara Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
  • Smedby, Karin E. Karolinska Institute, Stockholm, Sweden
  • Spina, Valeria Institute of Oncology Research (IOR), Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
  • Bruscaggin, Alessio Institute of Oncology Research (IOR), Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
  • Wu, Wei Institute of Oncology Research (IOR), Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
  • Moia, Riccardo Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
  • Bianchi, Elena Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
  • Gerber, Bernhard Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
  • Zucca, Emanuele Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
  • Gillessen, Silke Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
  • Ghielmini, Michele Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
  • Cavalli, Franco Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
  • Stussi, Georg Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
  • Hess, Mark A. University of Texas MD Anderson Cancer Center, Houston, TX, USA
  • Baumann, Tycho S. Hospital Clinic, Barcelona, Spain
  • Neri, Antonino Department of Oncology and Hemato-Oncology, University of Milan, Italy
  • Ferrarini, Manlio Department of Experimental Medicine, University of Genoa, Italy
  • Rosenquist, Richard Karolinska Institute, Stockholm, Sweden
  • Forconi, Francesco Cancer Sciences Division, University of Southampton, United Kingdom - Southampton University Hospital Trust, United Kingdom
  • Foà, Robin Division of Hematology, Sapienza University, Rome, Italy
  • Pospisilova, Sarka Interní Hematologická a Onkologická Klinika (IHOK), University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
  • Morabito, Fortunato Biotechnology Research Unit Aprigliano, Cosenza, Italy - Augusta Victoria Hospital, Jerusalem, Israel
  • Stilgenbauer, Stephan Department of Internal Medicine III, University Hospital of Ulm, Germany
  • Döhner, Hartmut Department of Internal Medicine III, University Hospital of Ulm, Germany
  • Parikh, Sameer A. Mayo Clinic, Rochester, MN, USA
  • Wierda, William G. University of Texas MD Anderson Cancer Center, Houston, TX, USA
  • Montserrat, Emili Hospital Clinic, Barcelona, Spain - Institute of Hematology and Oncology, University of Barcelona, Spain
  • Gaidano, Gianluca Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
  • Hallek, Michael Center of Integrated Oncology Cologne Bonn and German CLL Study Group, University of Cologne, Germany
  • Rossi, Davide Institute of Oncology Research (IOR), Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland
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    21.05.2020
Published in:
  • Blood. - 2020, vol. 135, no. 21, p. 1859–1869
English Most patients with chronic lymphocytic leukemia (CLL) are diagnosed with early-stage disease and managed with active surveillance. The individual course of patients with early-stage CLL is heterogeneous, and their probability of needing treatment is hardly anticipated at diagnosis. We aimed at developing an international prognostic score to predict time to first treatment (TTFT) in patients with CLL with early, asymptomatic disease (International Prognostic Score for Early-stage CLL [IPS-E]). Individual patient data from 11 international cohorts of patients with early- stage CLL (n = 4933) were analyzed to build and validate the prognostic score. Three covariates were consistently and independently correlated with TTFT: unmutated immunoglobulin heavy variable gene (IGHV), absolute lymphocyte count higher than 15 × 109/L, and presence of palpable lymph nodes. The IPS-E was the sum of the covariates (1 point each), and separated low-risk (score 0), intermediate-risk (score 1), and high-risk (score 2-3) patients showing a distinct TTFT. The score accuracy was validated in 9 cohorts staged by the Binet system and 1 cohort staged by the Rai system. The C-index was 0.74 in the training series and 0.70 in the aggregate of validation series. By meta- analysis of the training and validation cohorts, the 5-year cumulative risk for treatment start was 8.4%, 28.4%, and 61.2% among low-risk, intermediate-risk, and high-risk patients, respectively. The IPS-E is a simple and robust prognostic model that predicts the likelihood of treatment requirement in patients with early-stage CLL. The IPS-E can be useful in clinical management and in the design of early intervention clinical trials.
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  • English
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Medicine
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https://susi.usi.ch/usi/documents/319207
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