title: Beta2-microglobulin is a better predictor of treatment-free survival in patients with chronic lymphocytic leukaemia if adjusted according to glomerular filtration rate.
abstract: Even in the era of newer and sophisticated prognostic markers, beta(2)-microglobulin (B2M) remains a simple but very powerful predictor of treatment-free survival (TFS) and overall survival (OS) in patients with chronic lymphocytic leukaemia (CLL). However, B2M levels are heavily influenced by the patient's glomerular filtration rate (GFR) and this study aimed to evaluate whether GFR-adjusted B2M (GFR-B2M) had improved prognostic value compared to unadjusted B2M in a cohort of over 450 consecutive CLL patients from two separate institutions. Multivariate analysis identified a significantly shorter TFS in patients who were ZAP-70 + (P < 0.001), with increased GFR-B2M (P < 0.001), and del(11q) or del(17p) as detected by fluorescence in situ hybridization (FISH; P < 0.001). When OS was evaluated by multivariate analysis, age 65 years or older (P < 0.001) and poor risk FISH abnormalities (P < 0.001) had a confirmed adverse prognostic impact, but the predictive value of GFR-B2M was lost in the validation analysis. In all survival models, B2M did not attain independent significance unless GFR-B2M was eliminated from the analysis. In conclusion, GFR-B2M is a better predictor of TFS than unadjusted B2M in CLL patients.
authors.affiliation: Department of Haematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. jdelgadog@santpau.cat
authors.forename: Julio
authors.initials: J
authors.lastname: Delgado
authors.forename: Guy
authors.initials: G
authors.lastname: Pratt
authors.forename: Neil
authors.initials: N
authors.lastname: Phillips
authors.forename: Javier
authors.initials: J
authors.lastname: Briones
authors.forename: Chris
authors.initials: C
authors.lastname: Fegan
authors.forename: Josep
authors.initials: J
authors.lastname: Nomdedeu
authors.forename: Chris
authors.initials: C
authors.lastname: Pepper
authors.forename: Anna
authors.initials: A
authors.lastname: Aventin
authors.forename: Ramon
authors.initials: R
authors.lastname: Ayats
authors.forename: Salut
authors.initials: S
authors.lastname: Brunet
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: David
authors.initials: D
authors.lastname: Valcarcel
authors.forename: Donald
authors.initials: D
authors.lastname: Milligan
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000097:blood* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D015203:Reproducibility of Results; D015996:Survival Rate; D001613:beta 2-Microglobulin / Q000097:blood*
chemical_list: D014408:Biomarkers, Tumor; D001613:beta 2-Microglobulin; D003404:Creatinine