Clinical Stage at First Response May Predict Outcomes in Chronic Lymphocytic Leukemia

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Clinical stage determined by the Binet staging system could be an accurate response surrogate among patients with chronic lymphocytic leukemia.
Clinical stage determined by the Binet staging system could be an accurate response surrogate among patients with chronic lymphocytic leukemia.

Determining the clinical stage of patients with chronic lymphocytic leukemia (CLL) may be an effective prognostic marker for time to next therapy (TTNT) and overall survival (OS), according to a study published in Clinical Lymphoma Myeloma and Leukemia.1

Response to therapy is one of the most important predictors of survival among patients with cancer. The authors hypothesized that clinical stage determined by the Binet staging system — particularly the heterogeneous International Workshop on CLL (IWCLL) partial response (PR) category — could be an accurate response surrogate among this patient population.

For this study, researchers retrospectively assessed the outcomes of 229 patients with CLL previously treated with chemotherapy and/or immunotherapy. Using the IWCLL criteria, PRs according to changes in Binet clinical stage were separated into the PR-A, PR-B, and PR-C subcategories. Patients who had PR-B and PR-C were placed into the same group due to the small number of patients in these categories.

The median follow-up period was 91 months. Overall, 92 patients achieved an IWCLL PR during the course of treatment and 66 had responses that could be subcategorized according to Binet clinical staging; 76% (50) and 24% (16) had Binet stage A and B/C, respectively. The median number of previous lines of therapy was 2.

Results show that patients who had a PR-A at time of response evaluation had a significantly longer median TTNT of 26 months (95% CI, 16-36) compared with 11 months (95% CI, 6-16) among patients who had PR-B/C (P = .001).

Benefits in TTNT translated into OS benefit; the median OS for patients in the PR-A group was 63 months (95% CI, 39-87) compared with 43 months (95% CI, 38-48) for patients in the PR-B/C group (P = .047).

When the analysis was limited to the response assessment of patients after first-line therapy,  the TTNT was 23 months versus 4 months for patients with PR-A and PR-B/C, respectively (P < .001), and the OS was 164 months and 91 months, respectively.

The authors concluded that “changes in the Binet clinical stage could be an easy measure and a useful adjunct to, or surrogate of, the response to therapy for CLL. Because our study was in part hypothesis generating, prospective validation of the results in homogeneously treated patients is required.”


  1. Vicente EP, Cuellar-Garcia C, Martinez M, et al. Chronic lymphocytic leukemia: clinical stages maintain their prognostic significance over the course of the disease and are surrogates for response to therapy [published online June 27, 2018]. Clin Lymphoma Myeloma Leuk. doi: 10.1016/j.clml.2018.06.023

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