Andersen Michael Asger, Grand Mia Klinten, Brieghel Christian, Siersma Volkert, Andersen Christen Lykkegaard, Niemann Carsten Utoft
Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark.
Commun Med (Lond). 2022 May 12;2:50. doi: 10.1038/s43856-022-00117-4. eCollection 2022.
The dynamics of pre-diagnostic lymphocytosis in patients with ensuing chronic lymphocytic leukemia (CLL) need to be explored as a better understanding of disease progression may improve treatment options and even lead to disease avoidance approaches. Our aim was to investigate the development of lymphocytosis prior to diagnosis in a population-based cohort of patients with CLL and to assess the prognostic information in these pre-diagnostic measurements.
All patients diagnosed with CLL in the Greater Copenhagen area between 2008 and 2016 were included in the study. Pre-diagnostic blood test results were obtained from the Copenhagen Primary Care Laboratory Database encompassing all blood tests requested by Copenhagen general practitioners. Using pre-diagnostic measurements, we developed a model to assess the prognosis following diagnosis. Our model accounts for known prognostic factors and corresponds to lymphocyte dynamics after diagnosis.
We explore trajectories of lymphocytosis, associated with known recurrent mutations. We show that the pre-diagnostic trajectories are an independent predictor of time to treatment. The implementation of pre-diagnostic lymphocytosis slope groups improved the model predictions (compared to CLL-IPI alone) for treatment throughout the period. The model can manage the heterogeneous data that are to be expected from the real-world setting and adds further prognostic information.
Our findings further knowledge of the development of CLL and may eventually make prophylactic measures possible.
对于后续发展为慢性淋巴细胞白血病（CLL）的患者，其诊断前淋巴细胞增多的动态变化需要进行探究，因为更好地了解疾病进展可能会改善治疗方案，甚至可能带来疾病预防方法。我们的目的是在一个基于人群的CLL患者队列中研究诊断前淋巴细胞增多的发展情况，并评估这些诊断前测量中的预后信息。
纳入2008年至2016年在大哥本哈根地区诊断为CLL的所有患者。诊断前的血液检测结果来自哥本哈根初级保健实验室数据库，该数据库包含哥本哈根全科医生要求的所有血液检测。利用诊断前的测量结果，我们开发了一个模型来评估诊断后的预后。我们的模型考虑了已知的预后因素，并与诊断后的淋巴细胞动态变化相对应。
我们探索了与已知复发性突变相关的淋巴细胞增多轨迹。我们表明，诊断前的轨迹是治疗时间的独立预测因素。在整个治疗期间，诊断前淋巴细胞增多斜率分组的实施改善了模型预测（与单独使用CLL-IPI相比）。该模型可以处理来自现实世界环境中预期的异质性数据，并增加了进一步的预后信息。
我们的研究结果进一步加深了对CLL发展的认识，并最终可能使预防措施成为可能。
