Chronic lymphocytic leukemia in young (<= 55 years) patients: a comprehensive analysis of prognostic factors and outcomes

Abstract

ABSTRACTto evaluate the experience of CLL patients who were ≤55 years of age at the time of diagnosis. The threshold of ≤55 years was selected to classify age based on a similar cutoff used to define young CLL patients in historical studies. 5,7,29,30 Patients diagnosed with CLL between January 1995 and April 2012 and who fulfilled the 1996 criteria for CLL 31 and/or the World Health Organization (WHO) criteria for small lymphocytic lymphoma 32 were included in this analysis. Rai stage was ascertained within 12 months of the initial diagnosis. Since FISH results can change during the course of disease or after treatment, 33 only pre-treatment FISH results were used in this study. To adjust for potential referral bias, we compared the characteristics of patients who resided within 120 miles of the Mayo Clinic (excluding the twin cities of Minneapolis and St. Paul) to those who resided >120 milesaway. 34,35 The clinical characteristics and outcomes of CLL patients ≤55 years old were compared to those of CLL patients >55 years old. To further explore associations with patients with young onset CLL, those ≤aged 55 years were also divided into three groups based on their age at diagnosis: (i) ≤45 years, (ii) 46-50 years, and (iii) 51-55 years. The overall survival of patients ≤55 years old was also compared to that of the age-and sex-matched normal population of the state of Minnesota. The Mayo Clinic Institutional Review Board approved this study. Statistical analysisPatients' characteristics are summarized using medians and ranges for continuous variables and frequencies (percentages) for categorical variables. Overall survival was defined as time from diagnosis to date of death due to any cause or last follow-up time, whichever occurred first. Time to first treatment was defined as the time between the date of diagnosis and the date of initiation of treatment or date of last follow-up at which the patient was known to be untreated. Since the indications for treatment under both the 1996 31 and 2008 36 consensus criteria are identical, the indications to initiate treatment were consistent throughout the entire study interval. Expected survival was calculated using the cohort (Hakulinen) method 37 with estimates based on the age-and sexmatched Minnesota population.38 P values <0.05 were considered statistically significant. All statistical analyses were conducted using the SAS 9.2 software package (SAS Institute, Cary, NC, USA). More details on the methods and statistical analysis can be found in the Online Supplementary Appendix. Results Baseline characteristics of patients ≤ 55 years of age relative to those >55 years oldBetween January 1, 1995 and April 9, 2012, 844 patients ≤55 years old (median age, 50 years) with CLL were seen at the Mayo Clinic. A comparison of the baseline characteristics and prognostic profile of these patients relative to the 2324 CLL patients >55 years old (median age, 67 years) seen at the Mayo Clinic during the same time period is shown in Table 1. When compared to patients >55 years ol...

Chronic lymphocytic leukemia in the elderly: clinico-biological features, outcomes, and proposal of a prognostic model

“…In agreement with other reports, 16,21 elderly patients were treated less frequently than younger ones. There are various potential reasons for this, including less aggressive disease 21 and a more, not pre-determined conservative approach to the management of older subjects. Also, most elderly patients were given no effective therapies, which resulted in a lower overall response rate.…”

Chronic lymphocytic leukemia in young individuals revisited

“…Our knowledge of the clinical picture and behavior of CLL diagnosed at a young age does, however, come from studies conducted in the late 1980s 4,5 and 1990s, 6-9 a time when most biomarkers currently analyzed in CLL patients had not yet been discovered, [10][11][12][13] therapy was still based on alkylating agents, 14 and the role of allogeneic stem cell transplantation was not well established. 15 In this issue of Haematologica, Parikh et al 16 have reviewed the clinical and biological characteristics, and outcome of CLL patients diagnosed at ≤55 years of age. They compared the clinical and biological characteristics of 844 CLL patients ≤55 years, 55% of them with biomarkers available, with those of 2324 older patients followed-up at the Mayo Clinic from January 1995 to April 2012, and with the sex-and agematched general population.…”

Evaluation of Hypogammaglobulinemia in Chronic Lymphocytic Leukemia Patients and Its Relation to Poor Prognostic Factors

“…Parikh et al (24) divided 3168 patients into two groups as under and over 55 years age and found that 44% of patients younger than 55 years of age had stage 0, 53% had stage 1-2, 3% had stage 3-4 disease. 57% of patients over 55 years had stage 0, 37% had stage 1-2, and 6% had stage 2-4 disease.…”