Prognostic relevance of a scoring system based on clinical and biological parameters in early chronic lymphocytic leukemia.
BACKGROUND
Among patients with indolent form of B-cell chronic lymphocytic leukemia, some of them will progress into more advanced stages. To better define this subpopulation of patients, we attempted to define some parameters capable of predicting a pejorative clinical outcome.


METHODS
Eighty-eight previously untreated patients with B-cell chronic lymphocytic leukemia in Binet stage A were analysed to study the prognostic value of simple serological variables: soluble CD23 (sCD23), beta2 microglobulin (beta2m), lactate-dehydrogenase activities and albumin level. Results were compared to other conventional clinical and biological parameters by univariate and multivariate statistical analysis.


RESULTS
Our data show that: (1) among those studied, sCD23 >50 u/ml was the only serological significant parameter clearly correlated with disease progression and (2) stage A" patients (hemoglobin level between 100 and 120 g/l and/or lymphocytosis >30.10(9)/l), axillary lymph nodes and hypogammaglobulinemia were found to be other variables associated with a pejorative outcome. These four variables enabled the establishment of a scoring system, capable of predicting disease progression since 66% of the patients with a score < or =2 are going to evolve into advanced stages vs 12% with a score <2. Furthermore, the time to progression is shortened when the score is increasing.


CONCLUSIONS
Our findings show the prognostic relevance of a scoring system including sCD23 level. This score could be taken into account in the treatment strategy of B-cell chronic lymphocytic leukemia.
Leotard
S
S
Service d'Hématologie Biologique, Pitié-Salpêtrière Hospital, 47 Boulevard de l'Hôpital, 75013 Paris, France.
Chastang
C
C
Travade
P
P
Jaudon
M C
MC
Tournilhac
O
O
Baudet
S
S
Merle-Beral
H
H
D000328:Adult; D000361:Agammaglobulinemia / Q000209:etiology; D000368:Aged; D000704:Analysis of Variance; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000097:blood / Q000145:classification* / Q000401:mortality / Q000473:pathology; D008099:Liver / Q000473:pathology; D008198:Lymph Nodes / Q000473:pathology; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D017455:Receptors, IgE / Q000032:analysis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index; D013154:Spleen / Q000473:pathology; D001613:beta 2-Microglobulin / Q000032:analysis
D017455:Receptors, IgE; D012709:Serum Albumin; D001613:beta 2-Microglobulin; D007770:L-Lactate Dehydrogenase