A laboratory-based scoring system predicts early treatment in Rai 0 chronic lymphocytic leukemia

J.A. Cohen, F.M. Rossi, A. Zucchetto, R. Bomben, L. Terzi-Di-Bergamo, K.G. Rabe, M. Degan, A. Steffan, J. Polesel, E. Santinelli, I. Innocenti, G. Cutrona, G. D'Arena, G. Pozzato, F. Zaja, A. Chiarenza, D. Rossi, F. Di Raimondo, L. Laurenti, M. GentileF. Morabito, A. Neri, M. Ferrarini, C.D. Fegan, C.J. Pepper, G.D. Poeta, S.A. Parikh, N.E. Kay, V. Gattei

Research output: Contribution to journalArticlepeer-review


We present a laboratory-based prognostic calculator (designated CRO score) to risk stratify treatment-free survival in early stage (Rai 0) chronic lymphocytic leukemia (CLL) developed using a training-validation model in a series of 1,879 cases from Italy, the United Kingdom and the United States. By means of regression analysis, we identified five prognostic variables with weighting as follows: deletion of the short arm of chromosome 17 and unmutated immunoglobulin heavy chain gene status, 2 points; deletion of the long arm of chromosome 11, trisomy of chromosome 12, and white blood cell count >32.0×103/microliter, 1 point. Low-, intermediate- and high-risk categories were established by recursive partitioning in a training cohort of 478 cases, and then validated in four independent cohorts of 144 / 395 / 540 / 322 cases, as well as in the composite validation cohort. Concordance indices were 0.75 in the training cohort and ranged from 0.63 to 0.74 in the four validation cohorts (0.69 in the composite validation cohort). These findings advocate potential application of our novel prognostic calculator to better stratify early-stage CLL, and aid case selection in risk-adapted treatment for early disease. Furthermore, they support immunocytogenetic analysis in Rai 0 CLL being performed at the time of diagnosis to aid prognosis and treatment, particularly in today's chemofree era.

Original languageEnglish
Pages (from-to)1613-1620
Number of pages8
Issue number6
Publication statusPublished - 2020


  • adult
  • aged
  • Article
  • cancer specific survival
  • chromosome 17
  • chronic lymphatic leukemia
  • cohort analysis
  • fluorescence in situ hybridization
  • gene expression
  • gene frequency
  • gene mutation
  • human
  • in situ hybridization
  • learning algorithm
  • leukocyte count
  • major clinical study
  • male
  • nuclear magnetic resonance imaging
  • observational study
  • overall survival
  • risk factor
  • RNA splicing
  • scoring system
  • sensitivity analysis
  • white matter


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