Background: Chronic lymphocytic leukemia (CLL) is one of the most common hematologic malignancies, especially among elderlies. Several prognostic scores are available that utilize the characteristics of patients’ blood counts and cytogenetic anomalies—all are features of the disease rather than of the patient. Addressing the route of personalized rather than precise medicine, we refer to the assessment of patients’ status of sarcopenia and frailty. Low alanine aminotransferase (ALT) was already shown to function as a surrogate marker for sarcopenia and frailty. We decided to find a possible correlation between low ALT values and poor prognosis of CLL patients. Patients and Methods: This is a retrospective cohort study of CLL patients treated in a large, tertiary medical center, as outpatients or inpatients. Their frailty status was evaluated in a retrospective manner. We defined patients with ALT below 12 IU/L as frail and divided our cohort into two groups including a low ALT level group (ALT < 12) and a normal ALT level group (ALT≥12). Results: Overall, our final analysis included 716 CLL patients, of which 161 (22.5%) had ALT levels lower than 12 IU/L. There was no significant difference in patients’ age between the two groups. Patients with the low ALT had a lower hemoglobin concentration (median 10.8 g/dL [IQR = 2.7] vs. 12.2 [IQR = 3.1];p< 0.001) and a higher proportion of patients were classified as Binet C score [48.4% vs. 31.1%];p< 0.001). Frail CLL patients’ survival was significantly shorter when compared to non-frail patients, in both the univariate [HR = 1.6 [95% confidence interval, CI 1.23, 2.0];p< 0.01] and multivariate analyses [HR = 1.3 [95% CI 1.0, 1.7];p= 0.03]. Conclusions: Sarcopenia and frailty assessment, based on blood ALT measurements, could potentially point out differences in CLL patients’ prognoses. Such assessment could serve the purpose of treatment personalization of CLL patients.
背景：慢性淋巴细胞白血病（CLL）是最常见的血液系统恶性肿瘤之一，尤其在老年人群中高发。目前已有多种预后评分系统，这些系统主要依据患者血常规特征和细胞遗传学异常——这些均为疾病特征而非患者个体特征。为实现个体化医疗而非单纯精准医疗的目标，本研究关注患者肌肉减少症和衰弱状态的评估。已有研究表明，低丙氨酸氨基转移酶（ALT）水平可作为肌肉减少症和衰弱的替代标志物。本研究旨在探讨低ALT值与CLL患者不良预后之间可能存在的关联。 患者与方法：本研究为一项回顾性队列研究，纳入在一家大型三级医疗中心接受门诊或住院治疗的CLL患者。通过回顾性方式评估患者的衰弱状态。我们将ALT低于12 IU/L的患者定义为衰弱患者，并将队列分为两组：低ALT水平组（ALT < 12 IU/L）和正常ALT水平组（ALT ≥ 12 IU/L）。 结果：最终分析共纳入716例CLL患者，其中161例（22.5%）ALT水平低于12 IU/L。两组患者的年龄无显著差异。低ALT组患者的血红蛋白浓度较低（中位数10.8 g/dL [四分位距IQR = 2.7] vs. 12.2 g/dL [IQR = 3.1]；p < 0.001），且Binet C分期患者比例更高（48.4% vs. 31.1%；p < 0.001）。与非衰弱患者相比，衰弱CLL患者的生存期显著缩短，单变量分析[风险比HR = 1.6（95%置信区间CI 1.23, 2.0]；p < 0.01]和多变量分析[HR = 1.3（95% CI 1.0, 1.7]；p = 0.03]结果一致。 结论：基于血液ALT检测的肌肉减少症和衰弱评估，可能有助于识别CLL患者预后的差异。此类评估可为CLL患者的个体化治疗提供依据。
肿瘤(癌症)患者之家