Identifying patients with chronic lymphocytic leukemia without need of treatment: End of endless watch and wait?
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Identifying patients with chronic lymphocytic leukemia without need of treatment : End of endless watch and wait? / Brieghel, Christian; Galle, Veerle; Agius, Rudi; da Cunha-Bang, Caspar; Andersen, Michael A; Vlummens, Philip; Mattsson, Mattias; Rosenquist, Richard; Smedby, Karin E; Herling, Carmen D; Bahlo, Jasmin; Hallek, Michael; Lundgren, Jens D; Offner, Fritz; Niemann, Carsten U.
In: European Journal of Haematology, Vol. 108, No. 5, 2022, p. 369-378.Research output: Contribution to journal › Journal article › Research › peer-review
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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 -
ID: 307913295