Prognosis of chronic lymphocytic leukemia: a multivariate survival analysis of 150 cases

Rozmán, C; Montserrat, Emili; Feliú, Evarist; Grañena, A; Marı́n, Pedro; Nomdedeu, Benet; Corrons, JL Vives

doi:10.1182/blood.v59.5.1001.1001

Cited by 84 publications

(1 citation statement)

References 14 publications

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“…Table 3 The RAI staging for chronic lymphocytic leukemia (11) Stages Characteristics Survival The median survival of patients with chronic lymphocytic leukaemia was about nine years. Clinical stages, blood lymphocyte counts and morphology, bone marrow histopathological findings, serum lactate dehydrogenase, immunophenotyping ,and cytogenetic abnormalities are good predictors of survival [35][36][37][38][39] Table 3.…”

Section: Cytogeneticsmentioning

confidence: 99%

Update on diagnosis and treatment of Chronic Lymphocytic Leukemia (CLL)

Gamal Abdul Hamid,

Dalia Al-Alawi

2023

World J. Adv. Res. Rev.

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commonest leukemia found in adults western countries, affects more than 200000 people and is associated with approximately 4410 death in the USA annually. CLL is characterized by a progressive proliferation and accumulation of mature yet functionally incompetent lymphocytes. The disease typically occurs in elderly patients and has a highly variable clinical course. Leukemic transformation is initiated by specific genomic alterations that impair apoptosis of clonal B-cells. Diagnosis: The diagnosis of chronic lymphocytic leukemia (CLL) requires the presence of more than or equal to 5 × 109/L B lymphocytes (5000/μL) in the peripheral blood for the duration of at least 3 months. Immunophenotyping of circulating B-lymphocytes, which identify a clonal B-cell population carrying the CD5 antigen, as well as typical B-cell markers are confirmatory test. Prognosis: The two similar clinical staging systems, Binet and Rai stages, create prognostic information by using results of physical examination and blood counts. Various molecular biology markers also have prognostic value. Mutations of the TP53 gene and x chromosome 17 chromosome (del [17p) predict resistance to chemoimmunotherapy and a shorter time to progression, with most targeted therapies. A comprehensive, international prognostic score (CLL-IPI) integrates genetic, biological and clinical variables to identify distinct risk groups of CLL patients. Therapy: Early-stage disease of CLL patients are followed up regularly, only patients with active or symptomatic disease or with advanced stages of Binet or Rai require treatment. When treatment is indicated, most patients with CLL have several options: a combination of obinutuzumab and venetoclax, ibrutinib monotherapy, or immunochemotherapy. In patients under 65 years of age who are physically fit (particularly if they have a mutated IGVH gene), immunochemotherapy with fludarabine, cyclophosphamide, and rituximab remains the standard of care because of its potential therapeutic potential. In case of relapse, the initial treatment can be repeated if the treatment-free period exceeds 3 years. And in case of early recurrence of the disease, treatment should be switched to an alternative regime. Patients with del(17p) or TP53 mutations are another high-risk group and should be treated with targeted drugs. Allogeneic SCT can be considered in patients with TP53 or del(17p) mutations or in patients on inhibitor therapy.

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Section: Cytogeneticsmentioning

confidence: 99%

Update on diagnosis and treatment of Chronic Lymphocytic Leukemia (CLL)

Gamal Abdul Hamid,

Dalia Al-Alawi

2023

World J. Adv. Res. Rev.

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The significance of the bone marrow biopsy pattern in chronic lymphocytic leukemia: A prognostic dilemma

et al. 1999

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Although bone marrow biopsy pattern (BMBP) has long been suggested to be an independent prognostic factor in chronic lymphocytic leukemia (CLL), conflicting reports continue to appear in the literature. To investigate this issue we retrospectively reviewed 70 CLL patients who had undergone bone marrow biopsy at the time of diagnosis in a multivariate Cox regression analysis together with other prognostic factors. There were 51 (72.8%) males and 19 (27.2%) females with a median age of 60 years (range, 38-77). The median follow-up time was 24 months (range, 1-76), and median survival was 44 months. Thirtyfour patients (48.6%) had diffuse and 36 patients (51.4%) had nondiffuse BMBP (14 nodular, 11 interstitial, and 11 mixed). The median survival for diffuse and nondiffuse BMBP groups were 17 and 53 months, respectively (P= 0.05). Sixteen patients (22. 9%) had stage A, 28 (40.0%) stage B, and 26 (37.1%) stage C disease according to the Binet system, and four patients (5.7%) had low-risk, 39 (55.7%) intermediate-risk, and 27 (38.6%) high-risk disease according to the modified Rai staging system. The difference between the median survivals of patients in different stages was statistically significant (P < 0.0001). The BMBP and staging systems that are thought to be significant predictors of prognosis were used to build a multivariate Cox proportional hazard model. BMBP was not found to add additional information to the prognostic value of the staging systems. Our results underline two points: first, the significance of BMBP must be investigated in multivariate analysis including the stage, and second, BMBP is not a dynamic prognostic parameter, it is an index of tumor burden and does not add any prognostic information beyond that provided by clinical stage.

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Bone marrow histopathologic patterns and immunologic findings in B-chronic lymphocytic leukemia

Montserrat

Marques-Pereira

Gallart

et al. 1984

Cancer

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In 82 patients with B‐chronic lymphocytic leukemia, the correlations between the histopathologic bone marrow patterns (interstitial, nodular, mixed, and diffuse), serum immunoglobulin (Ig), and blood B‐lymphocyte levels and T‐lymphocyte levels have been analyzed. The most commonly lowered Ig class was IgM (43% of cases) followed by IgA (35%), and IgG (10%). There was a trend to a more frequent decrease of Ig levels when “advanced” bone marrow patterns (mixed + diffuse) were compared with the earlier ones (interstitial + nodular). The frequency of such a decrease was statistically significant for IgA class (P < 0.01). The absolute number of blood T‐lymphocytes was increased in the diffuse pattern (P < 0.01).

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Prognosis of chronic lymphocytic leukemia: a multivariate survival analysis of 150 cases

Cited by 84 publications

References 14 publications

Update on diagnosis and treatment of Chronic Lymphocytic Leukemia (CLL)

Update on diagnosis and treatment of Chronic Lymphocytic Leukemia (CLL)

The significance of the bone marrow biopsy pattern in chronic lymphocytic leukemia: A prognostic dilemma

Bone marrow histopathologic patterns and immunologic findings in B-chronic lymphocytic leukemia

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