engleski

Clinical staging and prognostic classification of B-chronic lymphocytic leukemia (B-CLL) : Important influence of age and sex

B-CLL is characterized by variable presentation, course, response to therapy and prognosis. Clinical staging and prognostic classifications reduce unpredicted variability by grouping the patients in more homogeneous subsets with respect to prognosis, thus allowing better design of clinical trials and improving evaluation of treatment results. However, each classification describes a different subset of patients and may therefore be more suitable in particular situations. In order to evaluate the prognostic significance and mutual relationship among age, sex, Rai stages, Binet stages, bone marrow failure and TTM score system parameters (TTMsize and TTMdistribution), we performed univariate and multivariate analyses in a series of 707 B-CLL patients with median age of 63 years and 64.4% males. Univariate analysis disclosed highly significant prognostic power (approximate chi-square enter) for: age (27.33), sex (12.75), Rai stages (71.84), Binet stages (81.66), bone marrow failure (48.32), TTMsize (64.19) and TTMdistribution (17.21), but not for therapy (0.01). All those variables were included in Cox proportional hazard model (global chi-square = 159.74), but only Binet stages (p = 0.000), age (p = 0.000), TTMsize (p = 0.000), sex (p = 0.003) and therapy (p = 0.023) were found to contribute independently to prognosis. Mutual relationship among parameters was also analyzed by performing uni- and multivariate analyses in defined subsets. Age was found to be significant prognostic factor in men, but not in women, while TTMdistribution was highly significant exclusively in women. Similarly, Rai stages were stronger prognostic predictors then Binet stages only in women. This strongly supports difference in nature of B-CLL between male and female patients. In patients younger than 70 years the strongest predictor of prognosis was TTMsize, followed by Binet stages and age, while in patients older then 70 the strongest predictor was Binet stage followed by age and therapy. In patients without bone marrow failure the strongest prognostic predictor was TTMsize, followed by age and Binet stage, while in patients with bone marrow failure the strongest predictor was age, followed by sex, TTMdistribution and therapy. We conclude that 1) simple clinical and laboratory data should be recorded quantitatively to allow application of different staging systems and prognostic classifications, since the prognostic power of given classification may vary in different patient subsets, 2) prognostic analysis, being one of the most powerful tools in clinical research may not only directly help rational clinical practice, but also may identify unexpected important associations, leading to better understanding of more general biological principles.

prognosis; non-Hodgkin's lymphoma

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