| Autor: |
Hoechstetter MA; Department of Internal Medicine I, München Klinik Schwabing, Munich, Germany., Busch R; Institute of Medical Statistics and Epidemiology, Technical University Munich, Munich, Germany., Eichhorst B; Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany., Bühler A; Department of Internal Medicine II, Klinikum Ingolstadt, Ingolstadt, Germany., Winkler D; Department of Internal Medicine II, Klinikum Ingolstadt, Ingolstadt, Germany., Bahlo J; Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany., Robrecht S; Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany., Eckart MJ; Internal Medicine, Hematology and Oncology Private Practice, Erlangen, Germany., Vehling-Kaiser U; Oncological Private Practice, Landshut, Germany., Jacobs G; Internal Medicine, Hematology and Oncology Private Practice, Saarbrücken, Germany., Jäger U; Department of Internal Medicine I, Division of Hematology and Hemostaseology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria., Hurtz HJ; Internal Medicine, Hematology and Oncology Private Practice, Halle, Germany., Hopfinger G; Department of Internal Medicine I, Division of Bone Marrow Transplantation, Medical University of Vienna, Vienna, Austria., Hartmann F; Department of Hematology and Oncology, Klinikum Lippe-Lemgo, Lemgo, Germany., Fuss H; Department of Hematology, Oncology and Palliative Medicine, Klinikum Bad Saarow, Bad Saarow, Germany., Abenhardt W; Hematology and Oncology Private Practice, Munich, Germany., Blau I; Hematology and Oncology Private Practice, Berlin, Germany., Freier W; Hematology and Oncology Private Practice, Hildesheim, Germany., Müller L; Hematology and Oncology Private Practice, Leer, Germany., Goebeler M; Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany., Wendtner C; Department of Internal Medicine I, München Klinik Schwabing, Munich, Germany.; Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany., Fischer K; Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany., Herling CD; Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany., Starck M; Department of Internal Medicine I, München Klinik Schwabing, Munich, Germany., Bentz M; Department of Internal Medicine III, Klinikum Karlsruhe, Karlsruhe, Germany., Emmerich B; Interdisciplinary Oncology Center (IOZ) Private Practice, Munich, Germany., Döhner H; Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany., Stilgenbauer S; Department of Internal Medicine III, University Hospital Ulm, Ulm, Germany., Hallek M; Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany. michael.hallek@uni-koeln.de. |
| Abstrakt: |
The heterogeneity of early stage CLL challenges prognostication, and refinement of prognostic indices for risk-adapted management in this population is essential. The aim of the multicenter, prospective CLL1 trial was to explore a novel prognostic model (CLL1-PM) developed to identify risk groups, separating patients with favorable from others with dismal prognosis. A cohort of 539 clinically, biochemically, and genetically characterized Binet stage A patients were observed until progression, first-line treatment, or death. Multivariate analysis identified six independent factors associated with overall survival (OS) and time-to-first treatment (TTFT): del(17p), unmutated IGHV, del(11q), ß2-microglobulin >3.5 mg/dL, lymphocyte doubling time (LDT) <12 months, and age >60 years. These factors were integrated into the CLL1-PM, which stratified patients into four risk groups. The CLL1-PM was prognostic for OS and TTFT, e.g., the risk of treatment at 5 years was 85.9, 51.8, 27.6, and 11.3% for very low (0-1.5), low (2-4), high (4.5-6.5), and very high-risk (7-14) scores, respectively (P < 0.001). Notably, in addition to factors comprising CLL-IPI, we substantiated del(11q) and LDT as prognostic factors in early CLL. Altogether, our findings would be useful to effectively stratify Binet stage A patients, particularly within the scope of clinical trials evaluating novel agents. |
Full text from SpringerLink