Identifying patients with chronic lymphocytic leukemia without need of treatment: End of endless watch and wait?

Identifying patients with chronic lymphocytic leukemia without need of treatment : End of endless watch and wait?

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 x 10(9)/L: 1 point; >30 x 10(9)/L; 2 points), beta 2-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.

Galle, VeerleGhent Univ Hosp, Dept Clin Hematol, Ghent, Belgium (författare)
Agius, RudiRigshosp, Dept Hematol, Copenhagen, Denmark (författare)
Da Cunha-Bang, CasparRigshosp, Dept Hematol, Copenhagen, Denmark (författare)
Andersen, Michael A.Rigshosp, Dept Hematol, Copenhagen, Denmark (författare)
Vlummens, PhilipGhent Univ Hosp, Dept Clin Hematol, Ghent, Belgium (författare)
Mattsson, MattiasUppsala universitet,Institutionen för immunologi, genetik och patologi,Uppsala Univ Hosp, Dept Hematol, Uppsala, Sweden(Swepub:uu)matma431 (författare)
Rosenquist, RichardKarolinska Institutet (författare)
Smedby, Karin E.Karolinska Institutet (författare)
Herling, Carmen D.Uniklin Koln, Dept Internal Med, Cologne, Germany (författare)
Bahlo, JasminUniklin Koln, Dept Internal Med, Cologne, Germany (författare)
Hallek, MichaelUniklin Koln, Dept Internal Med, Cologne, Germany (författare)
Lundgren, Jens D.Copenhagen Univ Hosp, Rigshosp, Ctr Hlth Immun & Infect Dis CHIP, Copenhagen, Denmark.;Univ Copenhagen, Fac Hlth Sci, Dept Clin Med, Copenhagen, Denmark (författare)
Offner, FritzGhent Univ Hosp, Dept Clin Hematol, Ghent, Belgium (författare)
Niemann, Carsten U.Rigshosp, Dept Hematol, Copenhagen, Denmark (författare)
Rigshosp, Dept Hematol, Copenhagen, DenmarkGhent Univ Hosp, Dept Clin Hematol, Ghent, Belgium (creator_code:org_t)

Ingår i:European Journal of Haematology: John Wiley & Sons108:5, s. 369-3780902-44411600-0609

Av författaren/redakt...: Brieghel, Christ ...; Galle, Veerle; Agius, Rudi; Da Cunha-Bang, C ...; Andersen, Michae ...; Vlummens, Philip; visa fler...; Mattsson, Mattia ...; Rosenquist, Rich ...; Smedby, Karin E.; Herling, Carmen ...; Bahlo, Jasmin; Hallek, Michael; Lundgren, Jens D ...; Offner, Fritz; Niemann, Carsten ...; visa färre...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Hematologi

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