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Evaluation of the CLL-IPI in relapsed and refractory chronic lymphocytic leukemia in idelalisib phase-3 trials

Jacob D Soumerai1,2, Ai Ni2, Guan Xing3

  • 1a Massachusetts General Hospital , Boston , MA , USA.

Leukemia & Lymphoma
|November 9, 2018
PubMed

Insights

The chronic lymphocytic leukemia International Prognostic Index (CLL-IPI) effectively predicts survival in relapsed patients receiving novel therapies. However, its risk categories may need adjustment for this specific patient group.

Area of Science:

  • Hematology
  • Oncology
  • Clinical Research

Background:

  • The chronic lymphocytic leukemia International Prognostic Index (CLL-IPI) is established for previously untreated patients.
  • Its utility in relapsed/refractory chronic lymphocytic leukemia (CLL) and novel therapies remains unevaluated.

Purpose of the Study:

  • To assess the prognostic value of the CLL-IPI in patients with relapsed/refractory CLL treated with idelalisib.
  • To identify key prognostic factors within the CLL-IPI in this setting.

Main Methods:

  • Retrospective analysis of 897 patients with relapsed/refractory CLL from three randomized trials of idelalisib.
  • Evaluation of CLL-IPI scores and individual factor prognostic significance for overall survival.

Main Results:

  • The CLL-IPI demonstrated significant prognostic value for survival in relapsed CLL (log-rank p < .0001, C-statistic 0.706).
  • High-risk categories (high and very high) comprised the majority of patients (84.9%).
  • Age >65, elevated β2-microglobulin, unmutated IGHV, and del17p/TP53 mutation were independently prognostic.

Conclusions:

  • The CLL-IPI is a valid prognostic tool for survival in relapsed CLL patients undergoing idelalisib therapy.
  • The distribution of risk categories suggests potential differences in the model's applicability to relapsed disease.
  • Re-evaluation of CLL-IPI variable weighting may enhance its optimization for relapsed/refractory CLL.

Keywords:
CLL-IPIChronic lymphocytic leukemiaidelalisibleukemialymphomaprognostication

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