TY - JOUR

T1 - Identifying patients with chronic lymphocytic leukemia without need of treatment

T2 - End of endless watch and wait?

AU - Brieghel, Christian

AU - Galle, Veerle

AU - Agius, Rudi

AU - da Cunha-Bang, Caspar

AU - Andersen, Michael A

AU - Vlummens, Philip

AU - Mattsson, Mattias

AU - Rosenquist, Richard

AU - Smedby, Karin E

AU - Herling, Carmen D

AU - Bahlo, Jasmin

AU - Hallek, Michael

AU - Lundgren, Jens D

AU - Offner, Fritz

AU - Niemann, Carsten U

N1 - © 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PY - 2022

Y1 - 2022

N2 - INTRODUCTION: Early-stage chronic lymphocytic leukemia (CLL) challenges specialized management and follow-up.METHODS: We developed and validated a prognostic index to identify newly diagnosed patients without need of treatment (CLL-WONT) by a training/validation approach using data on 4708 patients. Composite scores derived from weighted hazards by multivariable analysis defined CLL-WONT risk groups.RESULTS: Age (>65 years: 1 point), Binet stage (B: 2 points), lactate dehydrogenase (LDH) (>205 U/L: 1 point), absolute lymphocyte count (15-30 × 109 /L: 1 point; >30 × 109 /L; 2 points), β2-microglobulin (>4 mg/L: 1 point), IGHV mutation status (unmutated: 1 point), and 11q or 17p deletion (1 point) were independently associated with shorter time to first treatment (TTFT). Low-risk patients demonstrated 5-year TTFT of 2% by internal validation, but 7-19% by external validation. Including all patients with complete scores, the 5-year TTFT was 10% for the 756 (39%) CLL-WONT low-risk patients, and the 704 (37%) patients who were both CLL-WONT and CLL-IPI low risk demonstrated even lower 5-year TTFT (8%).CONCLUSION: We have adopted the CLL-WONT at an institution covering 1 800 000 individuals to allow patients with both low-risk CLL-WONT and CLL-IPI to be managed by primary healthcare providers, thereby prioritizing specialized hematology services for patients in dire need.

AB - INTRODUCTION: Early-stage chronic lymphocytic leukemia (CLL) challenges specialized management and follow-up.METHODS: We developed and validated a prognostic index to identify newly diagnosed patients without need of treatment (CLL-WONT) by a training/validation approach using data on 4708 patients. Composite scores derived from weighted hazards by multivariable analysis defined CLL-WONT risk groups.RESULTS: Age (>65 years: 1 point), Binet stage (B: 2 points), lactate dehydrogenase (LDH) (>205 U/L: 1 point), absolute lymphocyte count (15-30 × 109 /L: 1 point; >30 × 109 /L; 2 points), β2-microglobulin (>4 mg/L: 1 point), IGHV mutation status (unmutated: 1 point), and 11q or 17p deletion (1 point) were independently associated with shorter time to first treatment (TTFT). Low-risk patients demonstrated 5-year TTFT of 2% by internal validation, but 7-19% by external validation. Including all patients with complete scores, the 5-year TTFT was 10% for the 756 (39%) CLL-WONT low-risk patients, and the 704 (37%) patients who were both CLL-WONT and CLL-IPI low risk demonstrated even lower 5-year TTFT (8%).CONCLUSION: We have adopted the CLL-WONT at an institution covering 1 800 000 individuals to allow patients with both low-risk CLL-WONT and CLL-IPI to be managed by primary healthcare providers, thereby prioritizing specialized hematology services for patients in dire need.

KW - Aged

KW - Chromosome Aberrations

KW - Humans

KW - Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis

KW - Mutation

KW - Prognosis

KW - Risk Factors

U2 - 10.1111/ejh.13743

DO - 10.1111/ejh.13743

M3 - Journal article

C2 - 35030282

VL - 108

SP - 369

EP - 378

JO - Scandinavian Journal of Haematology

JF - Scandinavian Journal of Haematology

SN - 0902-4441

IS - 5

ER -