Abstract
Total body computed tomography (TB-CT) scan is not mandatory in the diagnostic/staging algorithm of chronic lymphocytic leukemia (CLL). The aim of this study was to determine the value and prognostic significance of TB-CT scan in early stage CLL patients. Baseline TB-CT scan was performed in 240 Binet stage A CLL patients (179 Rai low- and 61 Rai intermediate-risk) included in a prospective multicenter observational study (clinicaltrial.gov ID:NCT00917549). The cohort included 69 clinical monoclonal B lymphocytosis (cMBLs). Patients were restaged considering only radiological data. Following TB-CT scans, 20% of cases reclassified as radiologic Binet (r-Binet) stage B. r-Binet B patients showed a higher incidence of unfavorable cytogenetic abnormalities (P = 0.027), as well as a shorter PFS (P = 0.001). At multivariate analysis, r-Binet stage [HR = 2.48; P = 0.004] and IGHV mutational status [HR = 3.01; P = 0.002] retained an independent predictive value for PFS. Among 179 Rai low-risk cases, 100 were redefined as r-Rai intermediate-risk based upon TB-CT scan data, showing a higher rate of cases with higher ZAP-70 (P = 0.033) and CD38 expression (P = 0.029) and β2-microglobulin levels (P < 0.0001), as well as a shorter PFS than those with r-Rai low-risk (P = 0.008). r-Rai stage [HR = 2.78; P = 0.046] and IGHV mutational status [HR = 4.25; P = 0.009] retained a significant predictive value for PFS at multivariate analysis. Forty-two percent of cMBL patients were reclassified as r-small lymphocytic lymphomas (r-SLLs) by TB-CT scan. TB-CT scan appears to provide relevant information in early stage CLL related to the potential and the timing of patients to progress towards the more advanced disease stages.
Highlights
Chronic lymphocytic leukemia (CLL) patients show a variable clinical course with some cases having an almost normal progression-free life span and others require therapy shortly after diagnosis [1]
The studies investigating the clinical significance of Total body computed tomography (TB-computed tomography (CT)) scan in CLL are scanty
We investigated whether early stage CLL can be upstaged using TB-CT scan and whether these upstaged patients have clinical and biological characteristics and progression-free survival (PFS) differing from those who are not upstaged
Summary
Chronic lymphocytic leukemia (CLL) patients show a variable clinical course with some cases having an almost normal progression-free life span and others require therapy shortly after diagnosis [1]. For early stage patients it is virtually impossible to predict the clinical course. The use of serum indicators, i.e., b2-microglobulin [4] and free-light chains [5], along with molecular and cytogenetic markers [6] may provide valuable information, most of these markers are not routinely employed in clinical practice. Palermo, Italy; 17Unita Operativa di Medicina Interna, Presidio Ospedaliero di Matera, Italy; 18Unita di Ematologia e Trapianto di Cellule Staminali, IRCCS-CROB, Rionero in Vulture, Italy; 19Ematologia, A.O. San Martino, Genova, Italy; 20Divisione di Ematologia, Azienda Ospedaliera, Reggio Calabria, Italy; 21Divisione di Ematologia, Ospedale Civile, Piacenza, Italy; 22Divisione di Ematologia, Universita La Sapienza, Roma, Italy; 23Dipartimento di Oncologia ed Ematologia Universita di Modena Centro Oncologico Modenese, Policlinico Modena, Italy
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