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Measuring the Value of Prognostic Indexes for the Treatment of CLL


May 21, 2020

Prognosis indexes (PIs) may be helpful at improving clinical staging and assisting physicians in their practice, but more research with larger cohorts of patients are needed to fully understand the benefits of using PI to assess the time to first treatment in patients with early-stage (Binet A) chronic lymphocytic leukemia (CLL).

“The discovery of new biologic variables with high prognostic effect has been accompanied by the emergence of different PIs,” explained researchers in a study published in Clinical Lymphoma Myeloma and Leukemia. “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.”

The researchers utilized the five PI types for 428 unselected patients with Binet A CLL from a multicenter Spanish database with clinical and biologic information available. Then, the predictive value of the scores was assessed using Harrell’s concordance index (C index) and area under the receiver operating characteristic curve (AUC).

According to the results, the researchers found a significant association between time to first treatment and risk subgroups for all five PIs utilized. Predictive values for each PI ranked from most accurate to least accurate is as follows:

  1. IPS-A (C-index, 0.72; AUC, 0.76),
  2. CLL-01 (C-index, 0.69; AUC, 0.70),
  3. CLL-IPI (C-index, 0.69; AUC, 0.69),
  4. (C-index, 0.67; AUC, 0.69),
  5. The tailored approach (C-index, 0.61 and 0.58; AUC, 0.58 and 0.54).

“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,” the researchers concluded.

—Edan Stanley 

Reference:
Gascón Y Marín IG, Muñoz-Novas C, Figueroa I, et al. Prognosis Assessment of Early-Stage Chronic Lymphocytic Leukemia: Are We Ready to Predict Clinical Evolution Without a Crystal Ball? [published online ahead of print, 2020 Apr 13]. Clin Lymphoma Myeloma Leuk. 2020;S2152-2650(20)30136-1. doi:10.1016/j.clml.2020.03.003

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