Can Prognosis Assessments Accurately Predict Time to First Treatment in Early-Stage CLL?
Posted: Thursday, July 30, 2020
Currently available prognostic models do not appear to have an acceptable level of accuracy for predicting the time to first treatment in patients with early-stage chronic lymphocytic leukemia (CLL), according to a retrospective analysis published in Clinical Lymphoma, Myeloma & Leukemia. All five prognostic index models included in the analysis had moderate prognostic value for predicting the time to first treatment; however, “none of the scores w[ere] able to predict with total precision the clinical evolution, and, therefore, guide therapy decisions,” stated José-Ángel Hernández, MD, of Hospital Universitario Infanta Leonor, Madrid.
The researchers applied five prognostic index models—the CLL-IPI (International Prognostic Index), CLL-01, IPS-A (International Prognostic Score A), Barcelona-Brno, and a tailored approach (classification based on IGHV mutation status)—to a cohort of 428 patients with early-stage (Binet A) treatment-naive CLL from a multicenter Spanish database. The median patient age at diagnosis was 64 years, and 68% of patients had mutated IGHV status. The predictive value of the scores was assessed using Harrell’s concordance index (C index).
A significant association between the time to first treatment and risk subgroups was identified for all five prognostic index models. The most accurate model was the IPS-A (C index = 0.72; AUC = 0.76), followed by CLL-01 (C index = 0.69; AUC = .70), CLL-IPI (C index = 0.69; AUC = 0.69), Barcelona-Brno (C index = 0.67; AUC =0 .69), and the tailored approach (C index = 0.61 and 0.58; AUC = 0.58 and 0.54). The concordance between the five prognostic index models included in the analysis, however, was low (44%).
The only variable included in all five prognostic index models was IGHV mutation status, one of the variables with the highest hazard ratios in the study. “This suggests that IGHV mutation status might be the most powerful parameter for predicting the prognosis of patients with early-stage CLL,” concluded the authors.
Disclosure: The study authors reported no conflicts of interest.