External validation on a prospective basis of a nomogram for predicting the time to first treatment in patients with chronic lymphocytic leukemia

Stefano Molica, Diana Giannarelli, Massimo Gentile, Giovanna Cutrona, Nicola Di Renzo, Francesco Di Raimondo, Antonino Neri, Massimo Federico, Manlio Ferrrarini, Fortunato Morabito

Research output: Contribution to journalArticlepeer-review


Background: A nomogram that incorporates traditional and newer prognostic factors to identify patients with chronic lymphocytic leukemia (CLL) who are at high risk of receiving therapy was developed by investigators at The University of Texas M. D. Anderson Cancer Center (MDACC). Because the model required validation before its extensive use could be recommended, the authors sought to externally validate the nomogram in an independent, community-based cohort of patients with CLL. METHODS: In total, 328 previously untreated patients with newly diagnosed, asymptomatic, Binet stage A CLL from different primary hematology centers who were registered on a prospective basis during 2006 to 2010 on an observational database of the Italian Lymphoma Study Group were considered suitable for external validation of the model. RESULTS: A total point score was calculated for each patient using a formula proposed by MDACC investigators, and the median score was 19.9 (range, 0-69.5). Furthermore, when the score was evaluated as continuous variable (ie, by measuring the risk of each point increase), the total point score was associated with the time to first treatment (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.02-1.05; P 2] = 0.966; P =.002). CONCLUSIONS: The current results confirmed the ability of a newly developed prognostic index to predict the time to first treatment among previously untreated patients with CLL who had early disease and extended the utility of the model to those with Rai stage 0 disease. In addition, the actual and predicted time to first treatment outcomes revealed good agreement, suggesting that, externally, the results provided by the model are well calibrated. Cancer 2013.

Original languageEnglish
Pages (from-to)1177-1185
Number of pages9
Issue number6
Publication statusPublished - Mar 15 2013


  • early chronic lymphocytic leukemia
  • nomogram validation
  • prognostic index
  • time to first treatment

ASJC Scopus subject areas

  • Cancer Research
  • Oncology


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