Literatür Detay Bilgisi
Chronic lymphocytic leukemia in the elderly: clinico-biological features, outcomes, and proposal of a prognostic model

Yazarlar : Baumann T, Delgado J, Santacruz R

Yayın : Haematologica

Yayın Yılı : 2014

Pubmed Linki :

Konu : Geriyatrik Hematoloji

Literatür İçeriği : Abstract We investigated the clinico-biological features, outcomes, and prognosis in 949 patients with chronic lymphocytic leukemia according to age. No biological differences (cytogenetics by fluorescent in situ hybridization, IGHV, ZAP-70, CD38, NOTCH1, SF3B1) were found across age groups. Elderly patients (>70 years; n=367) presented more frequently with advanced disease (Binet C/Rai III-IV: 10/12% vs. 5/5%; p<.001), were treated less frequently (23.8% vs. 41.9% at 3 years; p<.001) and in most cases received no highly effective regimens thereby achieving a lower overall response rate (49% with 14% complete response vs. 69%with 31% complete response; p<.001). They also had shorter overall survival (6.6 vs. 13.3 years; p<.001) and higher disease-unrelated mortality (34.9% vs. 6.9% at 10 years; p<.001). However, disease-attributable mortality was not significantly different between both groups. Combining Binet stage, ZAP-70, beta2-microglobulin and comorbidity two risk groups (low-risk: 0-1 parameters; high-risk: 2-4 parameters) with different overall survival (median: 6.8 vs. 11.4 years, p<.001) were identified. In patients requiring treatment, comorbidity at treatment (Cumulative Illness Rating Scale-T>4; hazard ratio 2.2, p<001) and response (Failure vs. Response: hazard ratio 1.60, p<.04) were the most important prognostic factors for overall survival. In conclusion, in our series elderly patients with chronic lymphocytic leukemia presented with no distinct biological features as compared to younger ones and had a poorer clinical outcome. This study highlights the importance of a comprehensive medical care, achieving response to therapy, and specific management strategies for elderly patients with chronic lymphocytic leukemia.

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