title: Chronic lymphocytic leukemia in the elderly: clinico-biological features, outcomes, and proposal of a prognostic model.
abstract: We investigated the clinico-biological features, outcomes, and prognosis of 949 patients with chronic lymphocytic leukemia according to age. No biological differences (cytogenetics by fluorescent in situ hybridization, IGHV, ZAP-70, CD38, NOTCH1, SF3B1) were found across age groups. Elderly patients (>70 years; n=367) presented more frequently with advanced disease (Binet C/Rai III-IV: 10/12% versus 5/5%; P<0.001), were treated less frequently (23.8% versus 41.9% at 3 years; P<0.001) and in most cases did not receive highly effective regimens and thus had a lower overall response rate (49% with 14% having complete responses versus 69% with 31% having complete responses; P<0.001). The elderly patients also had a shorter overall survival (6.6 versus 13.3 years; P<0.001) and higher disease-unrelated mortality (34.9% versus 6.9% at 10 years; P<0.001). However, disease-attributable mortality was not significantly different between younger and older patients. A combination of Binet stage, ZAP-70 level, β2-microglobulin concentration and comorbidity identified two risk groups (low-risk: 0-1 parameters; high-risk: 2-4 parameters) with different overall survivals (median: 6.8 versus 11.4 years, P<0.001). In patients requiring treatment, comorbidity at treatment (Cumulative Illness Rating Scale-T>4; hazard ratio 2.2, P<0.001) and response (treatment failure versus response: hazard ratio 1.60, P<0.04) were the most important prognostic factors for overall survival. In conclusion, in our series, elderly patients with chronic lymphocytic leukemia did not present with any biological features distinct from those of younger patients, but did have a poorer clinical outcome. This study highlights the importance of comprehensive medical care, achieving response to therapy, and specific management strategies for elderly patients with chronic lymphocytic leukemia.
authors: Institute of Hematology and Oncology, Department of Hematology, University of Barcelona, Barcelona, Spain Hematopathology Unit, Pathology Department, University of Barcelona, Barcelona, Spain.
authors: Tycho
authors: T
authors: Baumann
authors: Institute of Hematology and Oncology, Department of Hematology, University of Barcelona, Barcelona, Spain.
authors: Julio
authors: J
authors: Delgado
authors: Institute of Hematology and Oncology, Department of Hematology, University of Barcelona, Barcelona, Spain.
authors: Rodrigo
authors: R
authors: Santacruz
authors: Institute of Hematology and Oncology, Department of Hematology, University of Barcelona, Barcelona, Spain Hematopathology Unit, Pathology Department, University of Barcelona, Barcelona, Spain.
authors: Alejandra
authors: A
authors: Martínez-Trillos
authors: Hematopathology Unit, Pathology Department, University of Barcelona, Barcelona, Spain.
authors: Cristina
authors: C
authors: Royo
authors: Hematopathology Unit, Pathology Department, University of Barcelona, Barcelona, Spain.
authors: Alba
authors: A
authors: Navarro
authors: Hematopathology Unit, Pathology Department, University of Barcelona, Barcelona, Spain.
authors: Magda
authors: M
authors: Pinyol
authors: Hematopathology Unit, Pathology Department, University of Barcelona, Barcelona, Spain.
authors: María
authors: M
authors: Rozman
authors: Department of Hemotherapy and Hemostasis; and Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
authors: Arturo
authors: A
authors: Pereira
authors: Hematopathology Unit, Pathology Department, University of Barcelona, Barcelona, Spain.
authors: Neus
authors: N
authors: Villamor
authors: Hematopathology Unit, Pathology Department, University of Barcelona, Barcelona, Spain.
authors: Marta
authors: M
authors: Aymerich
authors: Hematopathology Unit, Pathology Department, University of Barcelona, Barcelona, Spain.
authors: Cristina
authors: C
authors: López
authors: Hematopathology Unit, Pathology Department, University of Barcelona, Barcelona, Spain.
authors: Anna
authors: A
authors: Carrió
authors: Institute of Hematology and Oncology, Department of Hematology, University of Barcelona, Barcelona, Spain emontse@clinic.ub.es.
authors: Emili
authors: E
authors: Montserrat
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011379:Prognosis; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor