TY - JOUR
T1 - Multivariable model for time to first treatment in patients with chronic lymphocytic leukemia
AU - Wierda, William G.
AU - O'Brien, Susan
AU - Wang, Xuemei
AU - Faderl, Stefan
AU - Ferrajoli, Alessandra
AU - Do, Kim Anh
AU - Garcia-Manero, Guillermo
AU - Cortes, Jorge
AU - Thomas, Deborah
AU - Koller, Charles A.
AU - Burger, Jan A.
AU - Lerner, Susan
AU - Schlette, Ellen
AU - Abruzzo, Lynne
AU - Kantarjian, Hagop M.
AU - Keating, Michael J.
PY - 2011/11/1
Y1 - 2011/11/1
N2 - Purpose: The clinical course for patients with chronic lymphocytic leukemia (CLL) is diverse; some patients have indolent disease, never needing treatment, whereas others have aggressive disease requiring early treatment. We continue to use criteria for active disease to initiate therapy. Multivariable analysis was performed to identify prognostic factors independently associated with time to first treatment for patients with CLL. Patients and Methods: Traditional laboratory, clinical prognostic, and newer prognostic factors such as fluorescent in situ hybridization (FISH), IGHV mutation status, and ZAP-70 expression evaluated at first patient visit to MD Anderson Cancer Center were correlated by multivariable analysis with time to first treatment. This multivariable model was used to develop a nomogram - a weighted tool to calculate 2- and 4-year probability of treatment and estimate median time to first treatment. Results: There were 930 previously untreated patients who had traditional and new prognostic factors evaluated; they did not have active CLL requiring initiation of treatment within 3 months of first visit and were observed for time to first treatment. The following were independently associated with shorter time to first treatment: three involved lymph node sites, increased size of cervical lymph nodes, presence of 17p deletion or 11q deletion by FISH, increased serum lactate dehydrogenase, and unmutated IGHV mutation status. Conclusion: We developed a multivariable model that incorporates traditional and newer prognostic factors to identify patients at high risk for progression to treatment. This model may be useful to identify patients for early interventional trials.
AB - Purpose: The clinical course for patients with chronic lymphocytic leukemia (CLL) is diverse; some patients have indolent disease, never needing treatment, whereas others have aggressive disease requiring early treatment. We continue to use criteria for active disease to initiate therapy. Multivariable analysis was performed to identify prognostic factors independently associated with time to first treatment for patients with CLL. Patients and Methods: Traditional laboratory, clinical prognostic, and newer prognostic factors such as fluorescent in situ hybridization (FISH), IGHV mutation status, and ZAP-70 expression evaluated at first patient visit to MD Anderson Cancer Center were correlated by multivariable analysis with time to first treatment. This multivariable model was used to develop a nomogram - a weighted tool to calculate 2- and 4-year probability of treatment and estimate median time to first treatment. Results: There were 930 previously untreated patients who had traditional and new prognostic factors evaluated; they did not have active CLL requiring initiation of treatment within 3 months of first visit and were observed for time to first treatment. The following were independently associated with shorter time to first treatment: three involved lymph node sites, increased size of cervical lymph nodes, presence of 17p deletion or 11q deletion by FISH, increased serum lactate dehydrogenase, and unmutated IGHV mutation status. Conclusion: We developed a multivariable model that incorporates traditional and newer prognostic factors to identify patients at high risk for progression to treatment. This model may be useful to identify patients for early interventional trials.
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U2 - 10.1200/JCO.2010.33.9002
DO - 10.1200/JCO.2010.33.9002
M3 - Article
C2 - 21969505
AN - SCOPUS:80755127112
SN - 0732-183X
VL - 29
SP - 4088
EP - 4095
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 31
ER -