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.

Carolina Muñoz-Novas,María Poza-Santaella,José-Ángel Hernández,María Hernández-Sánchez,Isabel González-Gascón Y Marín,María-Ángeles Foncillas,Jesús-María Hernández-Rivas,Cecilia Heras,María-Stefania Infante,Ana-Eugenia Rodríguez-Vicente,Karen Marín

doi:10.1155/2018/9506979

Abstract

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 higher c-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.

Highlights

Chronic lymphocytic leukemia (CLL) is the most frequent leukemia in Western countries and is characterized by a marked clinical, molecular, and prognostic heterogeneity [1]
A total of 483 patients with CLL were included in the analysis of the MD Anderson Cancer Center (MDACC) prognostic index
Despite the discovery of new drugs focused on new targets, CLL is not considered curable

Summary

Introduction

Chronic lymphocytic leukemia (CLL) is the most frequent leukemia in Western countries and is characterized by a marked clinical, molecular, and prognostic heterogeneity [1]. While some patients without treatment have a life expectancy equal to that of the healthy population, others require treatment from the beginning of the disease and may even die within a short period of time [2,3,4]. For this reason, more than 35 years ago, the Rai [5] and Binet [6] classifications appeared. BioMed Research International process and to the patient From these results, it has been possible to establish new PIs that solve most of the limitations of classical staging systems. The study of somatic mutations in the variable region of the immunoglobulin heavy chain gene (IGHV) has shown that patients with mutated pattern have favorable outcome [8,9,10]

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Conclusion