Total body computed tomography (TB-CT) scan is not mandatory in the diagnostic/staging algorithm of chronic lymphocytic leukemia (CLL). The aim of this study was to determine the value and prognostic significance of TB-CT scan in early stage CLL patients. Baseline TB-CT scan was performed in 240 Binet stage A CLL patients (179 Rai low- and 61 Rai intermediate-risk) included in a prospective multicenter observational study (clinicaltrial.gov ID:NCT00917549). The cohort included 69 clinical monoclonal B lymphocytosis (cMBLs). Patients were re-staged considering only radiological data. Following TB-CT scans, 20% of cases re-classified as radiologic Binet (r-Binet) stage B. r-Binet B patients showed a higher incidence of unfavorable cytogenetic abnormalities (P=.027), as well as a shorter PFS (P=.001). At multivariate analysis, r-Binet stage [HR=2.48; P=.004] and IGHV mutational status [HR=3.01; P=.002] retained an independent predictive value for PFS. Among 179 Rai low-risk cases, 100 were re-defined as r-Rai intermediate-risk based upon TB-CT scan data, showing a higher rate of cases with higher ZAP-70 (P=.033) and CD38 expression (P=.029) and β2-microglobulin levels (P<.0001), as well as a shorter PFS than those with r-Rai low-risk (P=.008). r-Rai stage [HR=2.78; P=.046] and IGHV mutational status [HR=4.25; P=.009] retained a significant predictive value for PFS at multivariate analysis. 42% of cMBL patients were re-classified as r-small lymphocytic lymphomas (r-SLLs) by TB-CT scan. TB-CT scan appears to provide relevant information in early stage CLL related to the potential and the timing of patients to progress towards the more advanced disease stages.

Total body computed tomography scan in the initial work-up of binet stage a chronic lymphocytic leukemia patients : results of the prospective, multicenter o-cll1-gisl study / M. Gentile, G. Cutrona, S. Fabris, E.A. Pesce, L. Baldini, F. Di Raimondo, C. Musolino, P. Di Tonno, N. Di Renzo, S. Molica, M. Brugiatelli, F. Ilariucci, S. Zupo, S. Matis, F. Maura, E. Vigna, F. Angrilli, A.G. Recchia, G. Quarta, E. Iannitto, A. Fragasso, P. Musto, M. Spriano, I. Vincelli, D. Vallisa, A. Cortelezzi, F. R. Mauro, R. Foà, M. Federico, A. Neri, M. Ferrarini, F. Morabito. - In: AMERICAN JOURNAL OF HEMATOLOGY. - ISSN 0361-8609. - 88:7(2013 Apr 04), pp. 539-544. [Epub ahead of print] [10.1002/ajh.23448]

Total body computed tomography scan in the initial work-up of binet stage a chronic lymphocytic leukemia patients : results of the prospective, multicenter o-cll1-gisl study

S. Fabris;L. Baldini;F. Maura;A. Cortelezzi;A. Neri;
2013

Abstract

Total body computed tomography (TB-CT) scan is not mandatory in the diagnostic/staging algorithm of chronic lymphocytic leukemia (CLL). The aim of this study was to determine the value and prognostic significance of TB-CT scan in early stage CLL patients. Baseline TB-CT scan was performed in 240 Binet stage A CLL patients (179 Rai low- and 61 Rai intermediate-risk) included in a prospective multicenter observational study (clinicaltrial.gov ID:NCT00917549). The cohort included 69 clinical monoclonal B lymphocytosis (cMBLs). Patients were re-staged considering only radiological data. Following TB-CT scans, 20% of cases re-classified as radiologic Binet (r-Binet) stage B. r-Binet B patients showed a higher incidence of unfavorable cytogenetic abnormalities (P=.027), as well as a shorter PFS (P=.001). At multivariate analysis, r-Binet stage [HR=2.48; P=.004] and IGHV mutational status [HR=3.01; P=.002] retained an independent predictive value for PFS. Among 179 Rai low-risk cases, 100 were re-defined as r-Rai intermediate-risk based upon TB-CT scan data, showing a higher rate of cases with higher ZAP-70 (P=.033) and CD38 expression (P=.029) and β2-microglobulin levels (P<.0001), as well as a shorter PFS than those with r-Rai low-risk (P=.008). r-Rai stage [HR=2.78; P=.046] and IGHV mutational status [HR=4.25; P=.009] retained a significant predictive value for PFS at multivariate analysis. 42% of cMBL patients were re-classified as r-small lymphocytic lymphomas (r-SLLs) by TB-CT scan. TB-CT scan appears to provide relevant information in early stage CLL related to the potential and the timing of patients to progress towards the more advanced disease stages.
Settore MED/15 - Malattie del Sangue
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/219234
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