Development of a comprehensive prognostic index for patients with chronic lymphocytic leukemia

Natali Pflug, Jasmin Bahlo, Tait D. Shanafelt, Barbara F. Eichhorst, Manuela A. Bergmann, Thomas Elter, Kathrin Bauer, Gebhart Malchau, Kari G. Rabe, Stephan Stilgenbauer, Hartmut Döhner, Ulrich Jäger, Michael J. Eckart, Georg Hopfinger, Raymonde Busch, Anna-Maria Fink, Clemens-Martin Wendtner, Kirsten Fischer, Neil E. Kay and Michael Hallek

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  • New prognostic index for CLL patients: how, when, for whom?
    • Lukas Smolej, Associate Professor of Internal Medicine, consulting hematologist 4th Department of Internal Medicine - Hematology, University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic.

    Dr.Pflug et al report a novel comprehensive prognostic index for patients with chronic lymphocytic leukemia (CLL). They claim that "the index appears broadly applicable, dramatically improves the accuracy of prognostication over classical CLL clinical staging systems, and holds the potential for the development of more individualized treatment strategies. I congratulate the authors on completing such a demanging and important project. However, the analysis has several significant methodological problems which in my opinion affect its validity a preclude a widespread use of the prognostic index in routine practice: 1. The patient population is clearly affected by a strong selection bias - median age 60 years is much lower than 65-72 years in unselected CLL. In addition, the training cohort was validated by another biased cohort with median age of 61.5 years. Therefore, the tested cohorts are not representative of the general CLL population. 2. Most of the patients had available data from the time of the first-line therapy; thus, the results of dynamic markers which change in time (such as TK or B2M) are not valid for patients who would be tested at the time of CLL diagnosis. 3. The type of first-line therapy is one of the strongest predictive factors; the wide spectrum of first-line therapies therefore impairs the validity of the prognostic index. 4. We could speculate whether the abovementioned methodical issues were the reason why Rai/Binet clinical staging, an extre...

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    Conflict of Interest:
    None declared.