The prognostic value of a proliferation-inducing ligand (APRIL) serum levels in treatment-naive patients with chronic lymphocytic leukemia.

BACKGROUND/AIM A proliferation inducing ligand (APRIL) has been investigated as a prognostic marker in chronic lymphocytic leukemia (CLL) patients. However, there is no cut-off level for serum APRIL (sAPRIL) levels that predict time to treatment in CLL patients. MATERIALS AND METHODS Between May and December 2012, consecutive 94 CLL patients and 25 healthy controls were assessed. sAPRIL levels were measured by ELISA. Demographic data and the prognostic markers were obtained from the patients' files. Treatment-naive patients were followed up to 6.5 years for any treatment need. RESULTS Patients were divided into three groups: Treatment naive (n=47), chemotherapy receiving (n=25) and those who had received chemotherapy previously (n=22). No difference in median sAPRIL levels of patients who were receiving chemotherapy at the sampling time and the healthy controls indicates that sAPRIL levels might be influenced by treatment. For treatment naive patients, the best cut-off in predicting time to treatment was found at a sAPRIL level of 2.04 ng/ml, with 78% sensitivity and 63% specificity. Time to treatment was significantly earlier in APRIL high group (n=27) in APRIL low group (n=20) (p=0.010, log-rank test). CONCLUSION sAPRIL, a simple, promising blood test, which can be measured by ELISA, will seemingly attain a place in the wide range of prognostic markers in CLL. Prospective large-scale studies are required to validate and confirm the feasibility of the proposed cut-off level of 2.04 ng/ml as a predictor of time to treatment in treatment naive CLL patients.