PREDICTIVE INSTRUMENT FOR ASYMPTOMATIC EARLY-STAGE CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS-SINGLE CENTE EXPERIANCE

  • Sanja Trajkova University Clinic for Hematology, Faculty of Medicine , University St.Cyril and Methodius in Skopje, R. of North Macedonia
  • ALeksandra Pivkova-Veljanovska University Clinic for Hematology, Faculty of Medicine, University St.Cyril and Methodius in Skopje, R. of North Macedonia
  • Svetlana Krstevska-Balkanov University Clinic for Hematology, Faculty of Medicine, University St.Cyril and Methodius in Skopje, R. of North Macedonia
  • Nevenka Ridova University Clinic for Hematology, Faculty of Medicine, University St.Cyril and Methodius in Skopje, R. of North Macedonia
  • Simona Stojanovska University Clinic for Hematology, Faculty of Medicine, University St.Cyril and Methodius in Skopje, R. of North Macedonia
  • Bojan Labacevski Institute of Preclinical and Clinical Pharmacology with Toxicology , Faculty of Medicine, University St.Cyril and Methodius in Skopje, R. of North Macedonia
  • Irina Panovska-Stavridis University Clinic for Hematology, Faculty of Medicine, University St.Cyril and Methodius in Skopje, R. of North Macedonia

Abstract

Early-stage patients with Chronic  lymphocytic leukemia (CLL) are diagnosed without need for treatment, managed with following. The distinct course of the disease  is diverse, and  planing  treatment is barely projected at diagnosis. The aim of the study was first-time evaluation of  international prognostic score to predict time to first treatment (TFT) in patients with early stage CLL   (International Prognostic Score for Early-stage CLL IPS-E). Retrospective study of asymptomatic patients with CLL at early stage of disease in a period of time from January 2011 to January 2021. The median follow-up was 60 months (1-120 months). Individual patient data from 120 treatment-naïve CLL patients with Binet A stage were analyzed to composed International Prognostic Score for Early-stage CLL and correlated with Time to treatment failure (TTF).  Using IPS-E patients were distributed in three groups: low risk with 7, 5%, intermediate risk with 44 % and high risk patients 49%. Average TFS was 29, 3 months for low risk group, 28, 6 months for intermediate-risk group and 27,1 months for high-risk group. Using  prognostic  nomogram we calculated 5 years probability of survival for low, intermediate and high risk group: 73%, 72% and 70% respectively with projected median survival of 9, 1 year for low risk group and 9, 0 year, 8, 9 years for intermediate and high risk groups.


Keywords:  CLL, asymptomatic, early stage, IPS-E.


https://doi.org/10.55302/JMS2143081t

References

1. Abrisqueta P, Pereira A, Rozman C, et al. Improving survival in patients with chronic lymphocytic leukemia (1980-2008): the Hospital Clinic of Barcelona experience. Blood. 2009;114(10):2044-2050.
2. Hallek M, Cheson BD, Catovsky D, et al; International Workshop on Chronic Lymphocytic Leukemia. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood. 2008;111(12): 5446-5456.
3. Dighiero G, Maloum K, Desablens B, et al; French Cooperative Group on Chronic Lymphocytic Leukemia. Chlorambucil in indolent chronic lymphocytic leukemia. N Engl J Med. 1998;338(21):1506-1514.
4. Hoechstetter MA, Busch R, Eichhorst B, et al. Early, risk-adapted treatment with fludarabine in Binet stage A chronic lymphocytic leukemia patients: results of the CLL1 trial of the German CLL study group. Leukemia. 2017;31(12): 2833-2837.
5. Hallek M, Shanafelt TD, Eichhorst B. Chronic lymphocytic leukaemia. Lancet. 2018; 391(10129):1524-1537.
6. Langerbeins P, Bahlo J, Rhein C, et al. Ibrutinib versus placebo in patients with asymptomatic, treatment-na¨ıve early stage CLL: primary endpoint results of the phase 3 double-blind randomized CLL12 trial. Hematol Oncol. 2019;37(S2):38-40.
7. Condoluci A.,Lodovico Terzi di Bergamo L.,Langerbeins P.,at all. nternational prognostic score for asymptomatic early-stage chronic lymphocytic leukemia. Blood 2020; 135 (21): 1859–1869. doi: https://doi.org/10.1182/blood.2019003453.
8. Wierda WG, O’Brien S, Wang X, et al. Multivariable model for time to first treatment in patients with chronic lymphocytic leukemia. J Clin Oncol. 2011;29(31):4088-4095
9. Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018; 131(25):2745-2760.
10. Teras LR, DeSantis CE, Cerhan JR, Morton LM, Jemal A, Flowers CR. 2016 US lymphoid malignancy statistics by World Health Organization subtypes. CA Cancer J Clin. 2016; 66(6):443-459.
11. Abrisqueta P, Pereira A, Rozman C, et al. Improving survival in patients with chronic lymphocytic leukemia (1980-2008): the Hospital Clinic of Barcelona experience. Blood. 2009;114(10):2044-2050.
12. Molica S, Giannarelli D, Mirabelli R, et al. Reliability of six prognostic models to predict time-to-first-treatment in patients with chronic lymphocytic leukaemia in early phase. Am J Hematol. 2017;92(6):E91-E93.
13. International CLL-IPI working group. An international prognostic index for patients with chronic lymphocytic leukaemia (CLL-IPI): a meta-analysis of individual patient data. Lancet Oncol. 2016;17(6):779-790.
14. Best OG, Gardiner AC, Davis ZA, et al. A subset of Binet stage A CLL patients with TP53 abnormalities and mutated IGHV genes have stable disease. Leukemia. 2009;23(1): 212-214
15. Montserrat E, Bauman T, Delgado J. Present and future of personalized medicine in CLL. Best Pract Res Clin Haematol. 2016;29(1): 100-110. 46.
16. Baliakas P, Hadzidimitriou A, Sutton LA, et al; European Research Initiative on CLL (ERIC). Recurrent mutations refine prognosis in chronic lymphocytic leukemia. Leukemia. 2015;29(2):329-336.
17. Wierda WG, Byrd JC, Abramson JS, et al. NCCN Guidelines Insights: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, Version 2.2019. J Natl Compr Canc Netw. 2019;17(1):12-20.
Published
2021-12-28
How to Cite
TRAJKOVA, Sanja et al. PREDICTIVE INSTRUMENT FOR ASYMPTOMATIC EARLY-STAGE CHRONIC LYMPHOCYTIC LEUKEMIA PATIENTS-SINGLE CENTE EXPERIANCE. Journal of Morphological Sciences, [S.l.], v. 4, n. 3, p. 81-93, dec. 2021. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/vol4no3-12>. Date accessed: 22 oct. 2024.
Section
Articles