The CLL International Prognostic Index predicts outcomes in monoclonal B-cell lymphocytosis and Rai 0 CLL.
The CLL International Prognostic Index predicts outcomes in monoclonal B-cell lymphocytosis and Rai 0 CLL.
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DOI：
10.1182/blood.2020009813
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发表时间：
2021-07-15
期刊：
影响因子：
20.3
通讯作者：
Shanafelt TD
中科院分区：
文献类型：
--
作者：
Parikh SA;Rabe KG;Kay NE;Call TG;Ding W;Leis JF;Kenderian SS;Muchtar E;Wang Y;Koehler AB;Schwager SM;Lesnick CE;Kleinstern G;Van Dyke D;Hanson CA;Braggio E;Slager SL;Shanafelt TD
在本月的CME文章中，Parikh及其同事描述了对CLL国际预后指数（IPI）的微小调整，增加了淋巴细胞计数以测试其在单克隆B细胞淋巴细胞增多症或极早期慢性淋巴细胞白血病（CLL）（Rai 0期）患者中的效用。他们揭示，它可以预测这些患者的治疗时间和生存时间。由于大多数新的介绍适合这些类别，这些信息将是有价值的血液学家和病人一样。具有低、中和高/极高风险CLL-IPI评分的MBL需要治疗的5年风险分别为7%、14%和40%。与年龄和性别匹配的人群相比，具有高/极高风险CLL-IPI评分的Rai 0 CLL患者的生存期较短。慢性淋巴细胞白血病国际预后指数（CLL-IPI）在预测Rai 0期CLL和单克隆B细胞淋巴细胞增多症（MBL）患者预后方面的效用尚不清楚。我们确定了2001年1月1日至2018年10月1日期间在马约诊所就诊的969例患者（415例MBL和554例Rai 0 CLL;中位年龄64岁; 65%为男性），并确定了至首次治疗时间（TTFT）和总生存期（OS）。中位随访7年后，MBL需要治疗的疾病进展风险为2.9%/年（中位数，未达到），Rai 0 CLL为5%/年（中位数，10.4年）。在低、中和高/极高风险CLL-IPI风险组患者中，TTFT的估计5年风险分别为13.5%、30%和58%，P <0.0001（c-统计量= 0.69）;估计的5年OS分别为96.3%、91.5%和76%，P <0.0001（c-统计量= 0.65）。在对绝对B细胞计数与CLL-IPI个体因素的多变量分析中，绝对B细胞计数与TTFT缩短（每增加10 × 109/L的风险比[HR]：1.31; P < .0001）和OS缩短（HR：1.1; P = .02）相关。整个队列的OS与明尼苏达州年龄和性别匹配的一般人群相似（P = .17），尽管具有高和极高风险CLL-IPI评分的Rai 0 CLL患者的OS显著较短（分别为P = .01和P = .0001）。这项研究的结果表明，CLL-IPI能够预测从诊断到首次治疗的时间（不受治疗影响的终点），在一个大型患者队列中，疾病的唯一表现是循环克隆淋巴细胞群。
In this month’s CME article, Parikh and colleagues describe a minor adjustment to the CLL-International Prognostic Index (IPI), adding the lymphocyte count to test its utility in patients with either monoclonal B-cell lymphocytosis or very early–stage chronic lymphocytic leukemia (CLL) (Rai stage 0). They reveal that it predicts time to treatment and survival in these patients. As most new presentations fit into these categories, this information will be of value to hematologists and patients alike. The 5-year risk of needing therapy among MBL with low-, intermediate-, and high-/very high–risk CLL-IPI scores is 7%, 14%, and 40%, respectively. Survival of Rai 0 CLL patients with high-/very high–risk CLL-IPI score is shorter compared with age- and sex-matched population. The utility of the chronic lymphocytic leukemia-international prognostic index (CLL-IPI) in predicting outcomes of individuals with Rai 0 stage CLL and monoclonal B-cell lymphocytosis (MBL) is unclear. We identified 969 individuals (415 MBL and 554 Rai 0 CLL; median age, 64 years; 65% men) seen at Mayo Clinic between 1 January 2001 and 1 October 2018, and ascertained time to first therapy (TTFT) and overall survival (OS). After a median follow up of 7 years, the risk of disease progression needing therapy was 2.9%/y for MBL (median, not reached) and 5%/y for Rai 0 CLL (median, 10.4 years). Among patients with low, intermediate, and high/very high-risk CLL-IPI risk groups, the estimated 5-year risk of TTFT was 13.5%, 30%, and 58%, respectively, P < .0001 (c-statistic = 0.69); and the estimated 5-year OS was 96.3%, 91.5%, and 76%, respectively, P < .0001 (c-statistic = 0.65). In a multivariable analysis of absolute B-cell count with individual factors of the CLL-IPI, the absolute B-cell count was associated with shorter TTFT (hazard ratio [HR] for each 10 × 109/L increase: 1.31; P < .0001) and shorter OS (HR: 1.1; P = .02). The OS of the entire cohort was similar to that of the age- and sex-matched general population of Minnesota (P = .17), although Rai 0 CLL patients with high and very high-risk CLL-IPI score had significantly shorter OS (P = .01 and P = .0001, respectively). The results of this study demonstrate the ability of CLL-IPI to predict time from diagnosis to first treatment (an end point not affected by therapy) in a large cohort of patients whose only manifestation of disease is a circulating clonal lymphocyte population.
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