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Bone marrow histologic pattern--the best single prognostic parameter in
chronic lymphocytic leukemia: a multivariate survival analysis of 329 cases
C Rozman, E Montserrat, JM Rodriguez-Fernandez, R Ayats, T Vallespi, R Parody, A Rios, D Prados, M Morey and F Gomis
In previous studies, the prognostic value of bone marrow (BM) histologic
patterns in chronic lymphocytic leukemia (CLL) has been demonstrated. In
order to investigate whether such a value is independent of other
prognostic parameters, a multivariate survival analysis (Cox's regression
model) was undertaken in a series of 329 CLL patients in whom a BM had been
performed. The following binary variables were included in the analysis:
age (more than 60 years), lymphadenopathy (more than two areas involved),
splenomegaly, hepatomegaly, absolute lymphocyte count (more than 30,000
microL), anemia (hemoglobin less than 10 g/dL), thrombocytopenia (less than
100,000 microL), and BM pattern (diffuse v nondiffuse). Three variables
entered the regression at significant level: BM pattern (P less than .001),
anemia (P less than .001), and hepatomegaly (P = .03). The model was also
tested by expressing the variables in a continuous way when possible.
Again, BM pattern entered first in the regression (P less than .001),
followed by the hepatomegaly (P = .002), hemoglobin level (P = .02), and
lymphadenopathy (P = .04). When both the binary and the continuous models
were tested separately in 227 patients with BM as initial staging procedure
and in 102 patients in whom this was performed later during the course of
the disease, in all instances, BM pattern entered first in the regression
at a highly significant level. BM histologic pattern appears to be a better
single prognostic parameter than any one of the variables employed in
current clinical staging systems. A combined clinicopathologic system
incorporating the BM pattern, together with the usual clinical variables,
is presented.
Volume 64,
Issue 3,
pp. 642-648,
09/01/1984
Copyright © 1984 by The American Society of Hematology
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