背景:1996年美国国家癌症研究所工作组(NCI-WG96)指南将患有B细胞克隆的慢性淋巴细胞白血病(CLL)免疫表型的个体的疾病分类为CLL,如果其绝对淋巴细胞计数≥5×10(9)/L。如果绝对B细胞计数≥5×10(9)/L,则2008年国际CLL指南研讨会(IWCLL2008)将疾病分类为CLL;如果绝对B细胞计数<5×10(9)/L,则将其分类为单克隆B细胞淋巴细胞增多症(MBL)。奥姆斯特德县目前的研究目标,明尼苏达,评估这些变化对2000年至2010年发病率和报告的影响。
方法:使用罗切斯特流行病学项目和MayoCLL数据库提供的诊断指标,作者确定了2000年至2010年间所有新诊断的CLL和高MBL计数患者.确定了年龄特异性和性别特异性的发病率。
结果:根据NCI-WG96标准,在研究期间,有115例CLL患者和8例MBL患者。使用IWCLL2008分类,CLL患者79例,MBL患者40例。Rai阶段分布(低风险,中间风险,和高风险)使用NCI-WG96标准为60.9%,33.9%,5.2%,分别,与43%相比,49.4%,和7.6%,分别,使用IWCLL2008标准。CLL和MBL的年龄校正和性别校正发病率(每100,000)分别为10.0和0.66,使用NCI-WG96标准,分别为6.8和3.5,使用IWCLL2008标准。根据NCI-WG96标准的中位治疗时间为9.2年,而IWCLL2008标准为6.5年。
结论:使用IWCLL2008指南降低了CLL的发病率,在诊断时改变了初始Rai阶段的分布,缩短了中位治疗时间。
BACKGROUND: The 1996 National Cancer Institute Working Group (NCI-WG 96)
guidelines classified disease in individuals who had a B-cell clone with chronic lymphocytic leukemia (CLL) immunophenotype as CLL if their absolute lymphocyte count was ≥5 × 10(9)/L. The 2008 International Workshop on CLL
guidelines (IWCLL 2008) classified disease as CLL if the absolute B-cell count was ≥5 × 10(9)/L or as monoclonal B-cell
lymphocytosis (MBL) if the absolute B-cell count was <5 × 10(9)/L. The objective of the current study of Olmsted County, Minnesota, was to assess the effects of these changes on incidence rates and presentation from 2000 to 2010.
METHODS: Using diagnostic indices available through the Rochester Epidemiology Project and the Mayo CLL database, the authors identified all patients with newly diagnosed CLL and high-count MBL from 2000 to 2010. Age-specific and sex-specific incidence rates were determined.
RESULTS: According to NCI-WG 96 criteria, there were 115 patients with CLL and 8 patients with MBL during the period studied. Using the IWCLL 2008 classification, there were 79 patients with CLL and 40 patients with MBL. Rai stage distribution (low risk, intermediate risk, and high risk) using NCI-WG 96 criteria was 60.9%, 33.9%, and 5.2%, respectively, compared with 43%, 49.4%, and 7.6%, respectively, using IWCLL 2008 criteria. The age-adjusted and sex-adjusted incidence rates (per 100,000) for CLL and MBL were 10.0 and 0.66, respectively, using NCI-WG 96 criteria versus 6.8 and 3.5, respectively, using IWCLL 2008 criteria. The median time to treatment according to NCI-WG 96 criteria was 9.2 years versus 6.5 years with IWCLL 2008 criteria.
CONCLUSIONS: Use of the IWCLL 2008
guidelines reduced the incidence of CLL, altered the distribution of initial Rai stage at diagnosis, and shortened the median time to treatment.