title: A gender-based score system predicts the clinical outcome of patients with early B-cell chronic lymphocytic leukemia.
abstract: To facilitate the development of a prognostic model for early B-cell chronic lymphocytic leukemia (CLL), the Gruppo Italiano Malattie EMatologiche Maligne dell'Adulto (GIMEMA) proposes its multi-institutional effort as a working model. In total, 1138 newly diagnosed Binet stage A patients managed over the last 10 years outside the setting of clinical trials according to a "wait and see" policy form the basis of the present study aimed at investigating prognostic variables affecting disease progression, a surrogate endpoint for overall survival. A 3-stage risk system, simply obtained by summing the variables that proved significant in the multivariate analysis (i.e. short lymphocyte doubling time, advanced Rai substage, high peripheral blood lymphocytosis), is proposed. Clear-cut differences in the 10 year progression-free survival (PFS) were observed among patients scoring 0 (low risk), 1 (intermediate risk), 2-3 (high risk): 67.8, 41.0 and 24.8%, respectively (P<0.0001). The results of the Medical Research Council (MRC) suggesting a better clinical outcome for females prompted us to verify such a gender-related difference within our prognostic categories. Because changes in PFS only reflected gender for patients scoring 0 (P=0.04), the following prognostic subgroups are proposed: (1) females scoring 0; (2) males scoring 0; (3) patients scoring 1-3 whatever gender (10 year PFS: 76.2, 61.4 and 37.8%; P<0.00001). Our long-term database provides an adequate patient sample to generate a generalized risk stratification model based on clinical data. The indolent clinical outcome of women with early CLL is also supported by the higher frequency of the immunoglobulin heavy-chain variable (IgVH) mutational status and lower proportion of 17p and 11q deletions found in such a patient subset in the MRC CLL4 trial.
authors: Medical Oncology Unit, Department of Oncology & Hematology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy. smolica@libero.it
authors: Stefano
authors: S
authors: Molica
authors: Francesca R
authors: FR
authors: Mauro
authors: Vincenzo
authors: V
authors: Callea
authors: Massimo
authors: M
authors: Gentile
authors: Diana
authors: D
authors: Giannarelli
authors: Manuela
authors: M
authors: Lopez
authors: Francesco
authors: F
authors: Lauria
authors: Bruno
authors: B
authors: Rotoli
authors: Marco
authors: M
authors: Montanaro
authors: Agostino
authors: A
authors: Cortelezzi
authors: Vincenzo
authors: V
authors: Liso
authors: Franco
authors: F
authors: Mandelli
authors: Robin
authors: R
authors: Foa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome