© 1998 by Oxford University Press
Journal Of The National Cancer Institute, Vol 90, 850-858, Copyright © 1998 by Oxford University Press
J Hasford, M Pfirrmann, R Hehlmann, NC Allan, M Baccarani, JC Kluin-Nelemans, G Alimena, JL Steegmann and H Ansari
BACKGROUND: Interferon alfa is a conservative and widely used alternative
to bone marrow transplantation in treatment of patients with early chronic
myeloid leukemia (CML). A meta-analysis was conducted to develop a reliable
prognostic scoring system for estimation of survival of patients with CML
treated with interferon alfa. METHODS: Patients treated in prospective
studies, including major randomized trials, were separated into learning
and validation samples. Cox regression analysis and the minimum P-value
approach were used to identify prognostic factors for patient survival and
to discover groups in the learning sample with the greatest differences in
survival. These findings were then validated by applying the new scoring
system to patients in the validation sample. RESULTS: We collected data on
1573 patients who were participants in 14 studies involving 12
institutions; 1303 patients (learning sample, n = 981; validation sample, n
= 322) were eligible for inclusion in this analysis, and their median
survival time was 69 months (range, 1-117 months). Because two previously
described prognostic scoring systems failed to discriminate risk groups
satisfactorily, we developed a new scoring system that utilizes the
following covariates: age, spleen size, blast count, platelet count,
eosinophil count, and basophil count. Among 908 patients with complete data
in the learning sample, three distinct risk groups were identified (median
survival times of 98 months [n = 369; 40.6%], 65 months [n = 406; 44.7%],
or 42 months [n = 133;14.6%]; two-sided logrank test, P< or =.0001). The
ability of the new scoring system to discriminate these risk groups was
confirmed by analysis of 285 patients with complete data in the validation
sample (two-sided logrank test, P = .0002). CONCLUSIONS: A new prognostic
scoring system for estimating survival of patients with CML treated with
interferon alfa has been developed and validated through use of a large
dataset.
REVIEWS
A new prognostic score for survival of patients with chronic myeloid leukemia treated with interferon alfa. Writing Committee for the Collaborative CML Prognostic Factors Project Group
Institute for Medical Informatics, Biometry, and Epidemiology, University of Munich, Germany. has@ibe.med.uni-muenchen.de
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