Prognostic Tool Predicts Length of Watch and Wait Period in CLL

The appropriate gap between diagnosis of chronic lymphocytic leukemia (CLL) and treatment is now clearer as a new prognostic tool, IPS-E, that can predict the length of “watch and wait” has been introduced, according to a press release from the American Society of Hematology.¹

“Watch and wait” is the strategy that most guidelines for the treatment of CLL recommend for early-stage patients. Between 70% and 80% or approximately 400,000 patients diagnosed with CLL in the United States and Europe each year are early-stage individuals, and the curation of IPS-E is expected to decrease the amount of worry associated with patients having to wait for treatment.

"While some patients display a milder disease never requiring therapy, others present active disease shortly after diagnosis and require intervention," said lead study author Davide Rossi, MD, Institute of Oncology Research in Bellinzona, Switzerland. "The IPS-E is a simple and robust prognostic tool based on routine clinical and laboratory variables. The simplicity of IPS-E should facilitate its translation to the clinic."

To build the IPS-E, data were obtained from 4,933 patients with asymptomatic early-stage CLL from 11 international cohorts. The results were published inBlood.

The first cohort that was evaluated included 333 patients and staged by the Rai system. It was discovered that the time to first treatment (TTFT) correlated with covariates, including unmutated IGHV genes, absolute lymphocyte count >15 x109/l, and the presence of palpable lymph nodes. The covariates were given 1 point each, and the IPS-E was the sum of these covariates and separated low-risk patients who were given a score of 0, intermediate-risk patients who received a score of 1, and high-risk patients who were given a score of either 2 or 3. These scores demonstrated a definite TTFT.²

To validate the scoring system for the prognostic tool, data from the remaining 10 cohorts were assessed by the Binet staging system. The assessment identified 30% of patients as low risk, 35% as intermediate risk, and 35% as high risk. The score paralleled the actual results, which showed that 8.4% of patients in the low-risk category required treatment within 5 years versus 28.4% in the intermediate-risk category, and 61.2% in the high-risk category.

Rossi et al concluded that IPS-E is a robust and prognostic tool that can aid treatment in oncology practices as well as during early intervention clinical trials. The 3 tests required to determine the TTFT in patients with CLL are readily available to oncologists.

"The IPS-E can be regarded as a building block to which newly discovered independent outcome predictors for patients with early-stage CLL could be added," said Rossi.¹"A prospective study would help to further assess and eventually strengthen this prognostic tool."

References

1. New prognostic tool helps leukemia patients plan for cancer treatment [news release]. Washington, DC: American Society of Hematology; April 8, 2020.https://prn.to/3bb0fSt. Accessed April 10, 2020.
2. Condoluci A, Bergamo LT, Langerbeins P, et al. International prognostic score for asymptomatic early-stage chronic lymphocytic leukemia.Blood. 2019. Doi: 10.1182/blood.2019003453.