Haematologica. 2014 Jan;99(1):140-7. doi: 10.3324/haematol.2013.086066. Epub 2013 Aug 2.
The clinical characteristics and outcomes of younger (≤ 55 years) patients with chronic lymphocytic leukemia in the era of modern prognostic biomarkers and chemoimmunotherapy are not well understood. Baseline characteristics and outcomes of patients with chronic lymphocytic leukemia ≤ 55 years who were seen at the Mayo Clinic between January 1995 and April 2012 were compared with those of patients >55 years. The overall survival of patients ≤ 55 years was compared to that of the age- and sex-matched normal population. The characteristics of 844 newly diagnosed chronic lymphocytic leukemia patients ≤ 55 years old (median, 50 years) were compared to those of 2324 patients >55 years old (median, 67 years). Younger patients were more likely to have Rai stage I or II disease (P<0.0001), be IGHV unmutated (P=0.002) and express ZAP-70 (P=0.009). These differences became more pronounced when the ≤ 55 age group was sub-stratified into age ≤ 45, 46-50 and 51-55 years. After a median follow-up of 5.5 years, 426 (51%) patients ≤ 55 years old had received treatment, and 192 (23%) had died. The time to treatment was shorter in patients ≤ 55 years than in those older than 55 years (4.0 years versus 5.2 years; P=0.001) and those ≤ 55 years had longer survival (12.5 years versus 9.5 years; P<0.0001). However, patients ≤ 55 years had significantly shorter survival than the age- and sex-matched normal population (12.5 years versus not reached; P<0.0001). Our study is the first comprehensive analysis of younger patients with chronic lymphocytic leukemia in the modern era. Adverse prognostic markers appear more common among young patients. Although the survival of young chronic lymphocytic leukemia patients is longer than that of those >55 years old, their survival relative to the age- and sex-matched normal population is profoundly shortened.
在现代预后生物标志物和化疗免疫治疗时代，年轻（≤55 岁）慢性淋巴细胞白血病患者的临床特征和结局尚不清楚。比较了 1995 年 1 月至 2012 年 4 月在梅奥诊所就诊的≤55 岁和>55 岁慢性淋巴细胞白血病患者的基线特征和结局。将≤55 岁患者的总生存与年龄和性别匹配的正常人群进行比较。比较了 844 例新诊断的≤55 岁（中位年龄 50 岁）慢性淋巴细胞白血病患者和 2324 例>55 岁（中位年龄 67 岁）患者的特征。年轻患者更可能患有 Rai 分期 I 或 II 期疾病（P<0.0001）、IGHV 未突变（P=0.002）和表达 ZAP-70（P=0.009）。当将≤55 岁年龄组细分为≤45 岁、46-50 岁和 51-55 岁时，这些差异变得更加明显。中位随访 5.5 年后，844 例≤55 岁患者中有 426 例（51%）接受了治疗，192 例（23%）死亡。≤55 岁患者的治疗时间短于>55 岁患者（4.0 年比 5.2 年；P=0.001），且生存时间更长（12.5 年比 9.5 年；P<0.0001）。然而，≤55 岁患者的生存时间明显短于年龄和性别匹配的正常人群（12.5 年比未达到；P<0.0001）。本研究是对现代时代年轻慢性淋巴细胞白血病患者的首次综合分析。不良预后标志物在年轻患者中更为常见。尽管年轻慢性淋巴细胞白血病患者的生存时间长于>55 岁患者，但与年龄和性别匹配的正常人群相比，他们的生存时间显著缩短。
