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Defining the prognosis of early stage chronic lymphocytic leukaemia patients
Author(s) -
Pepper Chris,
Majid Aneela,
Lin Thet Thet,
Hewamana Saman,
Pratt Guy,
Walewska Renata,
Gesk Stefan,
Siebert Reiner,
Wagner Simon,
Kennedy Ben,
Miall Fiona,
Davis Zadie A.,
Tracy Ian,
Gardiner Anne C.,
Brennan Paul,
Hills Robert K.,
Dyer Martin J. S.,
Oscier David,
Fegan Chris
Publication year - 2012
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2011.08974.x
Subject(s) - ighv@ , stage (stratigraphy) , oncology , cd38 , medicine , univariate analysis , multivariate analysis , chronic lymphocytic leukemia , survival analysis , univariate , biology , multivariate statistics , leukemia , genetics , paleontology , stem cell , cd34 , statistics , mathematics
Summary Approximately 70% of chronic lymphocytic leukaemia (CLL) patients present with early stage disease, therefore defining which patients will progress and require treatment is a major clinical challenge. Here, we present the largest study of prognostic markers ever carried out in Binet stage A patients ( n = 1154) with a median follow‐up of 8 years. We assessed the prognostic impact of lymphocyte doubling time (LDT), immunoglobulin gene ( IGHV ) mutation status, CD38 expression, ZAP‐70 expression and fluorescence in situ hybridization (FISH) cytogenetics with regards to time to first treatment (TTFT) and overall survival (OS). Univariate analysis revealed LDT as the most prognostic parameter for TTFT, with IGHV mutation status most prognostic for OS. CD38 expression, ZAP‐70 expression and FISH were also prognostic variables; combinations of these markers increased prognostic power in concordant cases. Multivariate analysis revealed that only LDT, IGHV mutation status, CD38 and age at diagnosis were independent prognostic variables for TTFT and OS. Therefore, IGHV mutation status and CD38 expression have independent prognostic value in early stage CLL and should be performed as part of the routine diagnostic workup. ZAP‐70 expression and FISH were not independent prognostic markers in early stage disease and can be omitted at diagnosis but FISH analysis should be undertaken at disease progression to direct treatment strategy.