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Prognostic discrimination in "good-risk" chronic granulocytic leukemia
JE Sokal, EB Cox, M Baccarani, S Tura, GA Gomez, JE Robertson, CY Tso, TJ Braun, BD Clarkson and F Cervantes
The prognostic significance of disease features recorded at the time of
diagnosis was examined among 813 patients with Philadelphia chromosome-
positive, nonblastic chronic granulocytic leukemia (CGL) collected from six
European and American series. The survival pattern for this population was
typical of "good-risk" patients, and median survival was 47 mo. There were
multiple interrelationships among different disease features, which led to
highly significant correlations with survival for some that had no primary
prognostic significance, such as hematocrit. Multivariable regression
analysis indicated that spleen size and the percentage of circulating
blasts were the most important prognostic indicators. These features, and
age, behaved as continuous variables with progressively unfavorable import
at higher values. The platelet count did not influence survival
significantly at values below 700 X 10(9)/liter but was increasingly
unfavorable above this level. Basophils plus eosinophils over 15%, more
than 5% marrow blasts, and karyotypic abnormalities in addition to the Ph1
were also significant unfavorable signs. The Cox model, generated with four
variables representing percent blasts, spleen size, platelet count, and
age, provided a useful representation of risk status in this population,
with good fit between predicted and observed survival over more than a
twofold survival range. A hazard function derived from half of the patient
population successfully segregated the remainder into three groups with
significantly different survival patterns. We conclude that it should be
possible to identify a lower risk group of patients with a 2-yr survival of
90%, subsequent risk averaging somewhat less than 20%/yr and median
survival of 5 yr, an intermediate group, and a high- risk group with a 2-yr
survival of 65%, followed by a death rate of about 35%/yr and median
survival of 2.5 yr.
Volume 63,
Issue 4,
pp. 789-799,
04/01/1984
Copyright © 1984 by The American Society of Hematology
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