CLL: new score to determine the optimal timing of treatment initiation

  • Condoluci A & al.
  • Blood
  • 8 Apr 2020

  • curated by Pavankumar Kamat
  • Univadis Clinical Summaries
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Takeaway

  • 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.

Study design

  • 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. 

Key results

  • 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.

Limitations

  • Potential biases related to the timing of scheduled evaluations and premature censoring.