Prognosis of Binet stage A chronic lymphocytic leukemia patients: the strength of routine parameters

November 26, 2010

BlankBlood, 25 November 2010, Vol. 116, No. 22, pp. 4588-4590.

Prepublished online as a Blood First Edition Paper on August 25, 2010; DOI

10.1182/blood-2010-06-288274.

Prognosis of Binet stage A chronic lymphocytic leukemia patients: the strength

of routine parameters

Rémi Letestu13, Lévy4,5, Virginie Eclache13, Fanny Baran-Marszak13,

Dominique Vaur6, Dina Naguib6, Olivier Schischmanoff1,2,7, Sandrine Katsahian5,

Florence Nguyen-Khac8, Frédéric Davi8, Hélène Merle-Béral8, Xavier Troussard6,

and Florence Ajchenbaum-Cymbalista13

1 Université Paris13, Unité de Formation et de Recherche Santé-Médecine-Biologie

Humaine (UFR SMBH), Bobigny, France; 2 Unité Mixte de Recherche (UMR) U978,

Inserm, UFR SMBH, Bobigny, France; 3 Service d'Hématologie Biologique, Hôpital

Avicenne, Assistance Publique–Hôpitaux de Paris (AP-HP), Bobigny, France; 4 Pôle

Hématologie Oncologie, Hôpital Avicenne, AP-HP, Bobigny, France; 5 Inserm U717,

Hôpital Saint Louis, Paris, France; 6 Laboratoire d'Hématologie, Centre

Hospitalier de l'Université (CHU) Côte de Nacre, Caen, France; 7 Service de

biochimie, Hôpital Avicenne, AP-HP, Bobigny, France; and 8 Service d'Hématologie

Biologique, Hôpital Pitié Salpétrière, AP-HP, Paris, France

Recent developments in the management of chronic lymphocytic leukemia (CLL)

patients have made necessary the availability of dependable prognostic factors.

We have developed a prognostic index derived from the multivariate analysis of

339 stage A patients at diagnosis, exhaustively studied for classical and recent

predictive markers. Only 4 biologic parameters were found to be independent

predictors of progression-free survival (PFS): serum thymidine kinase (sTK),

lymphocytosis, ß2-microglobulin, and CD38 expression. Two groups were

distinguishable: cases with no or 1 risk factor (among whom 85% did not progress

after 7 years), and cases with 2 or more factors showing a median PFS of 20

months. Finally, we propose an easy, fast, cost-effective strategy for a

trustworthy prognostication in stage A patients, who currently represent more

than 80% of the CLL population, allowing physicians to adapt follow-up

individually.

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