Nowakowski et al identified risk factors associated with survival in a patient with chronic lymphocytic leukemia (CLL). These can help to identify a patient who may benefit from more aggressive management. The authors are from the Mayo Clinic.
Parameters from multivariate analysis of overall survival:
(1) percent smudge cells in a peripheral blood smear
(2) Rai stage
(3) percent CD38 positive cells
percent smudge cells in 200 lymphocytes =
= 100% * (number of smudge cells) / ((number of smudge cells) + (number of intact lymphocytes))
Parameter
Finding
Points
percent smudge cells
> 30%
1
<= 30%
0
Rai Stage
0, I or II
1
III or IV
0
percent CD38 positive cells
< 30%
1
>= 30%
0
where:
• The percent smudge cells was lower (worse prognosis) in Zap70 positive patients and in CD38 positive patients.
total number of factors associated with improved survival =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the score the better the overall survival.
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