Evolucion de la leucemia linfatica cronica: valor predictivo del inmunofenotipo, el CD23 soluble y la morfologia / Evolution of chronic lymphocytic leukemia: predictive value of immunophenotype, soluble CD23 and morphology

RESUMO

Some prognostic factors are useful in chronic lymphocytic leukemia (CLL) lymphocyte doubling time, clinical stage and bone marrow pattern infiltration, while others, such as the percentage of CD38+ cells, are under study and require confirmation. The objective of this study was to evaluate whether there is an association between morphology, lymphocyte immunophenotype, soluble CD23 (sCD23) and progression free survival (PFS). A total of 36 non-treated patients were enrolled. We analysed prospectively morphology (typical, mixed and PL-CLL); immunophenotypic profile (Matutes score); sCD23 plasma levels; clinical stage; lymphocyte doubling time; beta 2 microglobulin and karyotype abnormalities. Disease progression (need of treatment, progression to advanced stages, development of bulky organomegaly) and death related to disease were considered as events. Md of follow-up 24 mo. RESULTS: Stage 0 11/36, PFS 80%; I 10/36 PFS 90%; II 13/36; III and IV 2/36. SLE > or = II PFS 37%. p = 0.023. Lymphocyte doubling time < 12mo. 7/31; > 12mo. 24/31. PFS 28% vs. 80% p < 0.001. Karyotype normal 13/28, abnormal 15/28. PFS 92% vs. 54% p = 0.053. Trisomy 12 positive 7/30, negative 23/30, PFS 66% vs. 65%. beta 2 microglobulin normal 9/35; high 26/35. PFS 100% vs. 53% p = 0.006. sCD23 < 350 Ul/ml 15/32; > 350 Ul/ml 17/32. PFS 92% vs. 53% p = 0.005. Immunophenotype Score 5 15/36, Score 4 19/36, PFS 64%. Score 3 2/36. p = 0.516. Morphology typical 17/35, mixed 17/35, PFS 81% vs. 57%, p = 0.099. PL-CLL 1/35. CONCLUSIONS: sCD23 was suitable to predict PFS, specially useful for early stages without additional markers of active disease. Morphology (excluding PL-CLL) and immunophenotype, two common tools, were not useful for the study purpose: