title: Total body computed tomography scan in the initial work-up of Binet stage A chronic lymphocytic leukemia patients: Results of the prospective, multicenter O-CLL1-GISL study.
abstract: Total body computed tomography (TB-CT) scan is not mandatory in the diagnostic/staging algorithm of chronic lymphocytic leukemia (CLL). The aim of this study was to determine the value and prognostic significance of TB-CT scan in early stage CLL patients. Baseline TB-CT scan was performed in 240 Binet stage A CLL patients (179 Rai low- and 61 Rai intermediate-risk) included in a prospective multicenter observational study (clinicaltrial.gov ID:NCT00917549). The cohort included 69 clinical monoclonal B lymphocytosis (cMBLs). Patients were restaged considering only radiological data. Following TB-CT scans, 20% of cases reclassified as radiologic Binet (r-Binet) stage B. r-Binet B patients showed a higher incidence of unfavorable cytogenetic abnormalities (P = 0.027), as well as a shorter PFS (P = 0.001). At multivariate analysis, r-Binet stage [HR = 2.48; P = 0.004] and IGHV mutational status [HR = 3.01; P = 0.002] retained an independent predictive value for PFS. Among 179 Rai low-risk cases, 100 were redefined as r-Rai intermediate-risk based upon TB-CT scan data, showing a higher rate of cases with higher ZAP-70 (P = 0.033) and CD38 expression (P = 0.029) and β2-microglobulin levels (P < 0.0001), as well as a shorter PFS than those with r-Rai low-risk (P = 0.008). r-Rai stage [HR = 2.78; P = 0.046] and IGHV mutational status [HR = 4.25; P = 0.009] retained a significant predictive value for PFS at multivariate analysis. Forty-two percent of cMBL patients were reclassified as r-small lymphocytic lymphomas (r-SLLs) by TB-CT scan. TB-CT scan appears to provide relevant information in early stage CLL related to the potential and the timing of patients to progress towards the more advanced disease stages.
authors.affiliation: U.O.C. di Ematologia, Azienda Ospedaliera di Cosenza, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Gentile
authors.forename: Giovanna
authors.initials: G
authors.lastname: Cutrona
authors.forename: Sonia
authors.initials: S
authors.lastname: Fabris
authors.forename: Emanuela Anna
authors.initials: EA
authors.lastname: Pesce
authors.forename: Luca
authors.initials: L
authors.lastname: Baldini
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Raimondo
authors.forename: Caterina
authors.initials: C
authors.lastname: Musolino
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Tonno
authors.forename: Nicola
authors.initials: N
authors.lastname: Di Renzo
authors.forename: Stefano
authors.initials: S
authors.lastname: Molica
authors.forename: Maura
authors.initials: M
authors.lastname: Brugiatelli
authors.forename: Fiorella
authors.initials: F
authors.lastname: Ilariucci
authors.forename: Simona
authors.initials: S
authors.lastname: Zupo
authors.forename: Serena
authors.initials: S
authors.lastname: Matis
authors.forename: Francesco
authors.initials: F
authors.lastname: Maura
authors.forename: Ernesto
authors.initials: E
authors.lastname: Vigna
authors.forename: Francesco
authors.initials: F
authors.lastname: Angrilli
authors.forename: Anna Grazia
authors.initials: AG
authors.lastname: Recchia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Quarta
authors.forename: Emilio
authors.initials: E
authors.lastname: Iannitto
authors.forename: Alberto
authors.initials: A
authors.lastname: Fragasso
authors.forename: Pellegrino
authors.initials: P
authors.lastname: Musto
authors.forename: Mauro
authors.initials: M
authors.lastname: Spriano
authors.forename: Iolanda
authors.initials: I
authors.lastname: Vincelli
authors.forename: Daniele
authors.initials: D
authors.lastname: Vallisa
authors.forename: Agostino
authors.initials: A
authors.lastname: Cortelezzi
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Mauro
authors.forename: Robin
authors.initials: R
authors.lastname: Foà
authors.forename: Massimo
authors.initials: M
authors.lastname: Federico
authors.forename: Antonino
authors.initials: A
authors.lastname: Neri
authors.forename: Manlio
authors.initials: M
authors.lastname: Ferrarini
authors.forename: Fortunato
authors.initials: F
authors.lastname: Morabito
mesh_terms: D051997:ADP-ribosyl Cyclase 1 / Q000235:genetics; D000328:Adult; D000368:Aged; D001402:B-Lymphocytes / Q000378:metabolism / Q000473:pathology; D002869:Chromosome Aberrations; D018450:Disease Progression; D005260:Female; D015870:Gene Expression; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology; D008218:Lymphocytosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000235:genetics / Q000473:pathology; D008297:Male; D008562:Membrane Glycoproteins / Q000235:genetics; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D051746:ZAP-70 Protein-Tyrosine Kinase / Q000235:genetics; D001613:beta 2-Microglobulin / Q000235:genetics
chemical_list: D008562:Membrane Glycoproteins; D001613:beta 2-Microglobulin; D051746:ZAP-70 Protein-Tyrosine Kinase; C498154:CD38 protein, human; D051997:ADP-ribosyl Cyclase 1