Isabel González-Gascón-Y-Marín1, Carolina Muñoz-Novas2, Iñigo Figueroa3, María Hernández-Sánchez4, Ana-Eugenia Rodríguez-Vicente4, Miguel Quijada-Álamo4, Claudia Pérez-Carretero4, Carol Moreno5, Rosa Collado6, Blanca Espinet7, Anna Puiggros7, Natalia de Las Heras8, Francesc Bosch9, José-Ángel Hernández10. 1. Servicio de Hematología, Hospital Universitario Infanta Leonor, Madrid, Spain. Electronic address: igonzalezg@salud.madrid.org. 2. Servicio de Hematología, Hospital Universitario Infanta Leonor, Madrid, Spain. 3. Departamento de Medicina, Universidad Complutense, Madrid, Spain. 4. Instituto de Investigación Biomédica de Salamanca, Instituto de Biología Molecular y Celular del Cancer, Centro de Investigación del Cáncer, Universidad de Salamanca-Centro Superior de Investigaciones Científicas; and Servicio de Hematología, Hospital Universitario de Salamanca, Salamanca, Spain. 5. Servicio de Hematologia, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain. 6. Servicio de Hematología, Consorcio Hospital General Universitario, Valencia, Spain. 7. Laboratori de Citogenètica Molecular, Laboratori de Citologia Hematològica, Servei de Patologia i Servei de Hematologia, Hospital del Mar, Barcelona, Spain. 8. Servicio de Hematología y Hemoterapia, Complejo Asistencial Universitario, León, Spain. 9. Servicio de Hematología y Hemoterapia, Hospital Universitario Vall d'Hebron, Barcelona, Spain. 10. Servicio de Hematología, Hospital Universitario Infanta Leonor, Madrid, Spain; Departamento de Medicina, Universidad Complutense, Madrid, Spain.
Abstract
BACKGROUND: The discovery of new biologic variables with high prognostic effect has been accompanied by the emergence of different prognostic indexes (PIs) to assess the time to first treatment in patients with early-stage (Binet A) chronic lymphocytic leukemia (CLL). The present study compared the prognostic value of 5 PIs: CLL international prognostic index (CLL-IPI), Barcelona-Brno, international prognostic score-A (IPS-A), CLL-01, and a tailored approach. PATIENTS AND METHODS: We applied the 5 PIs to a cohort of 428 unselected patients with Binet A CLL from a multicenter Spanish database with clinical and biologic information available. The predictive value of the scores was assessed using Harrell's concordance index (C index) and area under the receiver operating characteristic curve (AUC). RESULTS: We found a significant association between time to first treatment and risk subgroups for all 5 PIs used. The most accurate PI was the IPS-A (C-index, 0.72; AUC, 0.76), closely followed by CLL-01 (C-index, 0.69; AUC, 0.70), 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). CONCLUSIONS: The concordance between the PIs was low (44%), suggesting that although all these PIs improve clinical staging and help physicians in routine clinical practice, it will be necessary to harmonize larger cohorts of patients to define the best PI for treatment decision-making in the real world.
BACKGROUND: The discovery of new biologic variables with high prognostic effect has been accompanied by the emergence of different prognostic indexes (PIs) to assess the time to first treatment in patients with early-stage (Binet A) chronic lymphocytic leukemia (CLL). The present study compared the prognostic value of 5 PIs: CLL international prognostic index (CLL-IPI), Barcelona-Brno, international prognostic score-A (IPS-A), CLL-01, and a tailored approach. PATIENTS AND METHODS: We applied the 5 PIs to a cohort of 428 unselected patients with Binet A CLL from a multicenter Spanish database with clinical and biologic information available. The predictive value of the scores was assessed using Harrell's concordance index (C index) and area under the receiver operating characteristic curve (AUC). RESULTS: We found a significant association between time to first treatment and risk subgroups for all 5 PIs used. The most accurate PI was the IPS-A (C-index, 0.72; AUC, 0.76), closely followed by CLL-01 (C-index, 0.69; AUC, 0.70), 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). CONCLUSIONS: The concordance between the PIs was low (44%), suggesting that although all these PIs improve clinical staging and help physicians in routine clinical practice, it will be necessary to harmonize larger cohorts of patients to define the best PI for treatment decision-making in the real world.
Authors: Emelie C Rotbain; Max J Gordon; Noomi Vainer; Henrik Frederiksen; Henrik Hjalgrim; Alexey V Danilov; Carsten U Niemann Journal: Blood Adv Date: 2022-04-26
Authors: Claudia Pérez-Carretero; Isabel González-Gascón-Y-Marín; Ana E Rodríguez-Vicente; Miguel Quijada-Álamo; José-Ángel Hernández-Rivas; María Hernández-Sánchez; Jesús María Hernández-Rivas Journal: Diagnostics (Basel) Date: 2021-05-10