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Progression and survival studies in early chronic lymphocytic leukemia
S Molica
Divisione di Ematologia, Ospedale Regionale A. Pugliese, Catanzaro, Italy.
To investigate the natural history of stage A chronic lymphocytic leukemia
(CLL) we reviewed 84 such patients. Among 74 cases evaluable for disease
progression, 22 (29.6%) progressed to more advanced clinical stages (9 to
stage B, 13 to stage C); the actuarial estimation of such an event at 4
years was 30% (95% CI: 26.3% to 33.6%). Despite a linear trend toward an
increasing risk (r = .92), the hazard function analysis showed a constant
pattern of progression, suggesting a lack of correlation of such an event
with time (r = .04). Furthermore, disease progression when analyzed as a
time-dependent variable had a clear-cut impact on survival (P less than
.001). With the aim of identifying a subgroup of patients with low
probability of disease progression and death, we applied to our set of
patients four different proposals for subclassifying stage A. All methods
were similar in terms of sample size, 5-year survival rate, and disease
progression risk, suggesting that the choice between different proposals is
somewhat arbitrary. Whatever the criteria are for defining "smoldering"
CLL, such patients (accounting in the present study for 20.5% of overall
series and 46.7% of stage A patients) should not be treated until
progression occurs.
Volume 78,
Issue 4,
pp. 895-899,
08/15/1991
Copyright © 1991 by The American Society of Hematology
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