- A simple prognostic model based on the sum of 3 routine tests could help clinicians decide when to start treatment for patients with chronic lymphocytic leukemia (CLL).
Why this matters
- Most patients with CLL are diagnosed at an early stage and managed with active surveillance; however, uncertainty remains about the timing of treatment initiation.
- Data from 11 international cohorts of patients with early-stage CLL (n=4933) were analyzed to develop and validate a score to predict the risk for the need for treatment within 1-5 years of diagnosis.
- Funding: Swiss Cancer League; European Research Council; Swiss National Science Foundation; Leukemia and Lymphoma Society; Italian Ministry of Health; Swedish Cancer Society.
- The combined scores of 3 key covariates were used to develop the score:
- Unmutated immunoglobulin heavy chain genes;
- Absolute lymphocyte count >15×109/L; and
- Presence of palpable lymph nodes.
- 1 point was allocated to each variable:
- 0 points: low risk;
- 1 point: intermediate risk; and
- 2-3 points: high risk.
- Cumulative risk for the need for treatment at 1 and 5 years, respectively, was:
- Low risk:
- Intermediate risk: 2.1% and 28.4%; and
- High risk: 14.1% and 61.2%.
- Validation of the system showed:
- 30% of patients as low risk;
- 35% as intermediate risk; and
- 35% as high risk.
- Potential biases related to the timing of scheduled evaluations and premature censoring.