THE ROLE OF IMAGING METHODS IN CHRONIC LYMPHOCYTIC LEUKEMIA: SIGNIFICANT INTERNAL LYMPHADENOPATHY IS FREQUENT AND ASSOCIATED WITH SHORTER OVERALL SURVIVAL

Sborník

Background. Chronic lymphocytic leukemia (CLL) is historically regarded as “liquid” malignancy but a significant subgroup of patients (pts) also presents with lymphadenopathy. With regard to extent of organomegaly, clinical staging systems by Rai and Binet rely solely on physical examination; the current version of NCI-WG guidelines for diagnosis and treatment of CLL does not recommend routine use of imaging methods in the management of CLL. However, several recent studies suggested that detection of internal lymphadenopathy may be associated with unfavourable prognosis. Aims. to evaluate the impact of internal lymphadenopathy on clinical course of pts with CLL. Patients and Methods. We performed a retrospective assessment of medical records from pts with CLL followed up at our institution between 2000-2010 who underwent a computer tomography (CT) of chest/abdomen or abdominal ultrasonography. A total of 301 pts were included (198 males, 103 females, median age, 63 years [range, 31-88]). Low/intermediate/high risk according to Rai modified staging was present in 38/50/12%. Results. During the course of CLL, internal lymphadenopathy was detected in 142 pts (48%): abdominal, 37%, mediastinal, 0.3%, abdominal and mediastinal, 11%. Bulky lymphadenopathy (defined as lymph nodes ≥ 5cm) developed during the course of the disease in 84 pts (28%). Interestingly, internal lymph nodes were frequently larger than palpable lymphadenopathy (45%; same size, 41%; external lymph nodes larger, 14%; n=117). Importantly, overall survival (OS) was significantly shorter in patients with internal lymphadenopathy (median 87 vs 124 months, p=0.024); there was also a trend towards shorter OS in pts with bulky lymph nodes (median 88 vs 112 months, p=n.s.). Conclusions. Our data strongly suggests that imaging methods should be incorporated into routine diagnostic workup of CLL as more than 51 % of pts had detectable internal lymphadenopathy during the course of the disease and 28% developed massive lymphadenopathy; in addition, patients with internal lymphadenopathy had shorter overall survival. These findings appear to have principal impact on the clinical management (decisions regarding therapy, adequate staging and assessment of therapeutic response, monitoring for relapse/progression). Updated results will be presented. Supported by Research Project MZO 00179906 from Ministry of Health, Czech Republic.

Haematologica, 2012; 97(s1):  302