Prognosis assessment of early-stage chronic lymphocytic leukemia. Are we ready to predict clinical evolution without a crystal ball?

ABSTRACT Background The discovery of new biological variables with high prognostic impact, has been accompanied by the emergence of different prognostic indexes (PI) to assess time to first treatment (TTFT) in early stage (Binet A) chronic lymphocytic leukemia (CLL) patients. This study aimed to compare the prognostic value of five PI: CLL-IPI, Barcelona-Brno, IPS-A, CLL-01 and Tailored approach. Patients and methods We applied the 5 PI in a cohort of 428 unselected Binet A CLL patients from a multicenter Spanish database with clinical and biological information. The predictive value of the scores was assessed with Harrell´s C index and receiver operating characteristic (ROC) curve (AUC). Results We found a significant association between TTFT and risk subgroups for all the PI used. The most accurate PI was the IPS-A (Harell´s C 0.72; AUC 0.76) closely followed by the CLL-01 (Harell´s C 0.69, AUC 0.70), the CLL-IPI (Harell´s C 0.69; AUC 0.69), the Barcelona-Brno (Harell´s C 0.67, AUC 0.69 ) and the tailored approach (Harell´s C 0.61 and 0.58, AUC 0.58 and 0.54) PI. Conclusion The concordance between indexes was low (44%) suggesting that although all these indexes significantly improve clinical staging and help physicians in routine clinical practice, it is necessary to harmonize larger cohorts of patients in order to define the best PI for treatment decision making in the real world.