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Prognostic Value of Residual Lymphadenopathy After Chemoimmunotherapy for CLL

By: Joseph Fanelli
Posted: Friday, November 15, 2019

According to a letter published in Leukemia, although abdominal lymph node status after front-line chemoimmunotherapy in patients with chronic lymphocytic leukemia (CLL) appears to be a prognostic factor for outcomes, the negative impacts of abdominal lymph nodes “exist independently” of minimal residual disease status after therapy. These findings, presented by Moritz Fürstenau, MD, of the University of Cologne, Germany, and colleagues, demonstrate the limited detection methods for minimal residual disease in patients with CLL.

“While [minimal residual disease] retains great prognostic significance within the group of [lymph node–positive] patients, the method is unable to fully capture disease biology and residual disease in the lymph node compartment,” the authors said. “While no residual disease might be measurable in blood or bone marrow, CLL cells seem to persist in enlarged lymph nodes and eventually lead to relapse.”

In their study, the authors included 361 patients who received front-line chemoimmunotherapy in three prospective German clinical trials. At final restaging, 62 patients (17.2%) demonstrated residual abdominal lymph node positivity, and 299 patients (82.8%) had no residual abdominal lymphadenopathy.

The investigators found that progression-free survival and overall survival were “significantly” shorter at final restaging in patients with residual abdominal lymphadenopathy (20.4 months and 57 months, respectively), compared with patients without abdominal lymph nodes (52.5 months and not reached, respectively). Among the 231 patients in whom minimal residual disease was available among peripheral blood, progression-free survival was also significantly shorter (34.7 months) in those with residual abdominal lymph nodes than in those without (75.6 months). Additionally, residual abdominal lymphadenopathy was associated with a lower rate of undetectable minimal residual disease in peripheral blood (51.2% in lymph node–positive patients vs. 75.8% in lymph node–negative patients) and in bone marrow (32.0% and 51.2%, respectively).

Disclosure: Full disclosure information of the study authors can be found at nature.com.



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