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Tumor burden status evaluated by computed tomography scan is of prognostic importance in patients with chronic lymphocytic leukemia

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Abstract

It has been discussed if computed tomography (CT) scan is necessary to perform or not, to provide prognostic information in patients with chronic lymphocytic leukemia. In the current National Institute Chronic lymphocytic leukemia Working Group (NCI-WG) guidelines, CT scan is not recommended outside clinical trials but states that further trials are warranted. Computed tomography scan of lymphadenopathy and/or splenomegaly was detected in totally 74 patients, leading to a modified Rai stage in 9 (12%) patients (from stage I to II). Using CT, 19 patients fulfilled the GELF high tumor burden criteria and/or one bulky node ≥7 cm. CT showed splenomegaly in totally 54 (73%) patients, of which 22 (41%) cases had not had been detected during clinical examination. According to the NCI response criteria for chronic lymphocytic leukemia (CLL), 15 (22%) patients showed a CR and 43 (62%) a PR, while when including CT findings, 12 (17%) fulfilled criteria for CR and 41 (59%) for PR. Patients with a high lymphadenopathy tumor burden according to the GELF criteria at the time of initiation of first-line therapy had a shorter time from response to next therapy or death, 12 months compared with 35 months for patients with less advanced lymphadenopathy (P = 0.002). There was also a trend for a shorter overall survival in the high tumor burden group, 58 months compared to 75 months (P = 0.098). Massive splenomegaly was related to a shorter therapy-free as well as overall survival. In our opinion, clinical examination is not sufficient for evaluation of abdominal lymphnodes and spleen in patients with therapy requiring CLL.

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Acknowledgments

The authors would like to thank Dr Bo Nilsson for excellent help with statistical analysis and Mrs Leila Relander for excellent secretarial help, which is highly appreciated. This study was supported by the Cancer Society in Stockholm, the Swedish Cancer Society. The authors reported no potential conflicts of interest.

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Authors and Affiliations

  1. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden

    Jeanette Lundin

  2. Department of Hematology, Karolinska University Hospital Solna, 171 76, Stockholm, Sweden

    Stefan Norin, Eva Kimby & Jeanette Lundin

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  1. Stefan Norin
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  2. Eva Kimby
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  3. Jeanette Lundin
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Correspondence to Jeanette Lundin.

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Norin, S., Kimby, E. & Lundin, J. Tumor burden status evaluated by computed tomography scan is of prognostic importance in patients with chronic lymphocytic leukemia. Med Oncol 27, 820–825 (2010). https://doi.org/10.1007/s12032-009-9292-y

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  • DOI: https://doi.org/10.1007/s12032-009-9292-y

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