Nowakowski et al identified a number of prognostic factors associated with survival in patients with chronic lymphocytic leukemia (CLL). The percentage of smudge cells in the peripheral blood smear is an easily measured risk factor. The authors are from the Mayo Clinic in Rochester.
Patient selection: CLL
Outcome: overall survival
Parameters:
(1) percent of smudge cells (as percent of total lymphocytes plus smudge cells)
(2) percent of lymphocytes that are CD38 positive by flow cytometry
(3) Rai stage
Parameter
Finding
Points
percent smudge cells
<= 30%
1
> 30%
0
percent CD38 positive
< 30%
0
>= 30%
1
Rai stage
I or II
0
III or IV
1
where:
• Each parameter had a hazard ratio in the range of 2.5 to 2.9.
total number of adverse prognostic factors =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The overall survival of the patients declines with the number of prognostic factors.
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