CLL/SLL

Which is more accurate for predicting OS and TTFT, CLL-IPI or MDACC-PI?

Massimo Gentile from the Azienda Ospedaliera of Cosenza, Consenza, Italy, and colleagues from across Italy and the US recently published data in a letter to the editor on the topic of comparing two prognostic tools for CLL in a community based cohort in Blood, October, 2016. The authors set out to compare and assess the validity of the recently published CLL-IPI and the MD Anderson Cancer Center Prognostic Index (MDACC-PI) scores for predicting OS and TTFT in newly diagnosed CLL patients. The data was collected from 858 patients across 5 Italian centers and, in a separate data set, 506 patients at the Mayo Clinic in the US.

Highlights:
  • 5-year OS of CLL-IPI groups in this study, similar to original publication
  • OS C-statistic: CLL-IPI = 0.71 (P<0.0001) vs. MDACC-PI = 0.68 (P<0.001)
  • TTFT C-statistic: CLL-IPI = 0.72 (P<0.001) vs. MDACC-PI = 0.63 (P<0.001)
  • Mayo Clinic OS C-statistic: CLL-IPI 0.75 (P<0.001) vs. MDACC-PI = 0.66 (P<0.001)
  • Mayo Clinic TTFT C-statistic: CLL-IPI 0.74 (P<0.001) vs. MDACC-PI = 0.66 (P<0.001)

 

The CLL-IPI is a more accurate prognostic predictor than MDACC-PI in terms of both OS and TTFT, in two separate populations, confirming the use of CLL-IPI. However, as MDACC-PI can be used without FISH (TP53) or IGHV, unlike CLL-IPI, it may still be useful in some settings. When taken together, this work validates the CLL-IPI for use in predicting both OS and TTFT in patients with newly diagnosed CLL.  

 References:
  1. Gentile M. et al. Validation of the CLL-IPI and comparison with the MDACC prognostic index in newly diagnosed patients. Blood. Oct 2016; 128:2093–2095. doi: 10.1182/blood-2016-07-728261.
  2. International CLL-IPI working group. An international prognostic index for patients with chronic lymphocytic leukaemia (CLL-IPI): a meta-analysis of individual patient data. Lancet Oncology. 2016 Jun; 17(6):779–790. doi: 10.1016/S1470-2045(16)30029-8. Epub 2016 May 13.
  3. Wierda W.G. et al. Prognostic nomogram and index for overall survival in previously untreated patients with chronic lymphocytic leukemia. Blood. 2007 Jun 1; 109(11):4679–4685. Epub 2007 Feb 13.