Natural history of chronic lymphocytic leukemia: on the progression and progression and prognosis of early clinical stages.

In chronic lymphocytic leukemia (CLL) clinical staging systems provide useful tools for establishing the prognosis and to plan therapy. Clinical staging systems, however, do not give information regarding disease progression. In this study the progression and survival of CLL in early clinical stages is analyzed. Among 261 patients with CLL, 134 (51%) were in stage A (M 60/F 74; mean age 64.2 years; DS = 11), and 87 (33%) in stage 0. Progression was analyzed as far as patients remained untreated (median: 11 months; range: 3-114). Thirty-three (24.6%) out of 134 patients in stage A progressed to more advanced stages (17 to B, 16 to C) with an actuarial cumulative risk for progression of 31% at 3 years. Variables at diagnosis predictive of a more likely progression were: number of lymph nodes involved (p less than 0.001), rapid lymphocyte doubling time (p = 0.0025), and markedly increased lymphocyte count (p = 0.02). Twenty-eight (32%) out of 87 patients in stage 0 progressed (8 to I, 12 to II, 7 to III), the actuarial cumulative risk being of 28% at 3 years. The only variable predictive of progression was a lower normal Hb level (p = 0.015). Although the survival probability of patients in stage A (0) was not statistically different from those in stage A (I, II), their median survivals were of 125.7 and 91 months, respectively. Concerning survival, the following poor prognostic variables were identified: stage A: advanced age (p = 0.01), and rapid lymphocyte doubling time (p = 0.0045). Stage 0: higher lymphocyte count (p = 0.005), and lower normal Hb level (p = 0.015).(ABSTRACT TRUNCATED AT 250 WORDS)