Principal clinical features and prognosis in chronic lymphocytic leukemia

A prospective study of 102 patients with chronic lymphocytic leukaemia (CLL) on 30 parameters subdivided into 77 variables was analyzed by correspondence analysis, a variant of principal component analysis, which allows simultaneous graphical representation of patients and variables. This statistical method clearly defined three principal clinical features recognized at the time of diagnosis: lymph node proliferation, lymphoid infiltration and cytopenia. Cytopenia was clearly subdivided into peripheral and central types. Each of these clinical features were derived from clinical and laboratory observations which agreed with each other. Simple examination permitted an evaluation of these three syndromes. They seemed to be independent of each other except for a relationship between central cytopenia and lymphoid infiltration. Thus clinical staging at the moment of diagnosis must record three scales of severity corresponding to the three independant clinical features. Prognosis was essentially related to cytopenia, whatever the mechanism. In a further analysis of the subsequent progress of the disease, a "common path" for patients was found terminating in a region of the graph where marked splenomegaly and cytopenia were plotted. We conclude that it is necessary to consider the three clinical features independently in a clinical staging. This study emphasizes the poor prognosis of cytopenia and splenomegaly and indicates that follow up and treatment should take this feature into account.