On the BALL to spot the best score able to predict overall survival in relapsed or refractory CLL
A partir de données portant sur 2 475 patients atteints d'une leucémie lymphocytaire chronique traitée entre 2012 et 2015, cette étude évalue la performance d'un système de score, basé sur les niveaux sériques de la microglobuline bêta 2, de la lactate déshydrogénase et de l'hémoglobine et basé également sur le délai avant le début du dernier traitement, pour prédire la survie globale chez les patients dont la maladie est récidivante ou réfractaire aux thérapies ciblées ou aux chimio-immunothérapies
Before 2014, therapeutic options for relapsed or refractory chronic lymphocytic leukaemia (CLL) were monoclonal antibodies (ofatumumab, alemtuzumab, rituximab) alone or in combination with chemotherapy (most of the time bendamustine). For the fittest and youngest patients, reduced intensity conditioning allogeneic stem-cell transplantation (RIC-alloSCT) was mandated in cases presenting with deletion 17p or TP53 mutation, and for those presenting with early relapsed disease (less than 24 months after last regimen). The worst prognosis was found in patients combining both refractoriness and alterations in the p53 pathway, with median overall survival of less than 1 year. A score predicting overall survival has been derived from frontline chemotherapy-based strategies (CLL-International Prognostic Index [CLL-IPI]), and further validated in the relapsed or refractory setting. The presence of p53 alterations is overweighed in this score (4 points out of 10), highlighting the detrimental effect of lacking adequate genotoxic stress responses when chemotherapy is applied. The International workshop in CLL (IwCLL) now recommends the search for deletion 17p or TP53 mutations before any line of therapy.
The Lancet Haematology , commentaire, 2018