ALBERT

Description: The most common staging systems for CLL were developed many years ago and are based on blood cell count and the presence of enlarged lymph nodes by physical exam. Many studies have tried to identify prognostic factors in early stage patients. A recent paper (Muntanola et al: Abdominal Computed Tomography Predicts Progression in Patients With Rai Stage 0 CLL. J Clin Oncol. 25:1576-1580) showed that patients with Rai 0 disease and a pathologic abdominal CT scan had a reduced time to progression (TTP), more similar to Rai stage I disease; however CT cannot be used routinely, especially in patients with early stage CLL, whose life expectancy may be very long. When compared to CT, ultrasonography (US) can be used at diagnosis and in follow-up, when it can show progression of abdominal lymph nodes. Patients and Methods The aims of the study were to investigate: 1) if a pathologic ultrasonography (PU) showing the presence of abdominal lymphadenopathy at diagnosis could allow identifying patients with different risk of evolution. 2) if there is a correlation between PU and different prognostic factors, such as mutational state, absolute lymphocyte count, CD38 positivity, age 3) if patients with Rai 0 disease and with PU are prognostically similar to Rai 1. Between 1999 and 2011, 189 patients with Rai 0 or Rai 1 CLL had a ultrasonography (US) performed at diagnosis. Lymph nodes more than 10 mm in diameter were considered abnormal. In 137 of them mutational status had been determined. Fluorescence in situ hybridization (FISH) analysis for 11,12, 13 17 was not generally performed at diagnosis but only before the beginning of treatment. The Fisher’s exact or t tests were used to analyze the association between the presence of an abnormal US and the clinical characteristics. Survival time and time to progression (TTP) were analyzed using the Kaplan-Meier method and curves were compared by means of the log-rank test. Results Mean age was 63.2 years (range 41-85). Patients had Rai stage 0 (n=130) disease or Rai stage 1 (n=59). Median absolute lymphocyte count was 12.2 x 10^9/L. Overall, PU were present in 40/189 (21.2%) patients, with dimensions of lymph nodes up to 120 mm. PU were significantly more frequent in patients with Rai 1 disease (23/59 – 39%) than in Rai 0 (17/130 – 13.1%) disease (p 20 x 10^9/L (15/47 – 31.9%) than in patients with absolute lymphocyte count at diagnosis 〈 20 x 10^9/L (25/142 – 17.6%) (p=0.03). No significant differences were present in age, hemoglobin concentration, absolute neutrophil count, platelet count or CD38 positivity. When all patients are considered, patients with PU had a shorter time to progression when compared to patients without PU (median 56 months vs not reached - p