文章：

β-2-微球蛋白在化疗免疫治疗与靶向药物两个治疗时代中，对肾功能受损的Binet A期慢性淋巴细胞白血病患者总体生存预测的维持作用

Beta-2-Microglobulin Maintains Overall Survival Prediction in Binet A Stage Chronic Lymphocytic Leukemia Patients with Compromised Kidney Function in Both Treatment Eras of Chemoimmunotherapy and Targeted Agents

原文发布日期：6 November 2024

DOI: 10.3390/cancers16223744

类型: Article

开放获取: 是

英文摘要：

Background: Elevated beta-2-microglobulin (B2M) plasma levels commonly imply a higher CLL-IPI risk category for short overall survival (OS), but the risk model was not adjusted for compromised kidney function and not validated in Binet A stage CLL patients.Methods: CLL patients were identified from 2000 to 2022 at Innsbruck University Hospital, Austria. B2M levels, CLL-IPI risk stratification, and kidney function were assessed. Treatment modalities in case of disease progression and OS data during follow-up were evaluated.Results: A total of 259 Binet A stage CLL patients were identified; 16.9% (n = 44/259) presented with concurrent chronic kidney disease (CKD, GFR < 60 mL/min). Median OS was 170 months and was similar in CKD and non-CKD patients (p= 0.25). The CLL-IPI facilitated prognostic segregation in both CKD (p= 0.02) and non-CKD patients (p= 0.008). Although more frequently elevated in CKD patients (44.1% versus 10.6%,p< 0.001), B2M > 3.5 mg/L remained associated with inferior OS in this subgroup (p= 0.03). Contrary to the CLL-IPI, the prognostic value of B2M alone was also maintained in CLL patients diagnosed and potentially treated frontline in the era of targeted agents (2014–2022,p= 0.03).Conclusions: B2M retains its prognostic value for OS in early-stage CLL patients with concurrent CKD and still represents a promising covariate for up-coming prognostic models to identify patients at high risk for inferior OS in the era of targeted agents.

摘要翻译： 

背景：血浆β2微球蛋白（B2M）水平升高通常提示慢性淋巴细胞白血病国际预后指数（CLL-IPI）风险分层较高且总生存期（OS）较短，但该风险模型未针对肾功能不全进行调整，亦未在Binet A期CLL患者中得到验证。 方法：本研究纳入2000年至2022年奥地利因斯布鲁克大学医院确诊的CLL患者。评估B2M水平、CLL-IPI风险分层及肾功能状态，分析疾病进展时的治疗方案及随访期间的OS数据。 结果：共纳入259例Binet A期CLL患者，其中16.9%（44/259）合并慢性肾脏病（CKD，肾小球滤过率<60 mL/min）。中位OS为170个月，CKD与非CKD患者间无显著差异（p=0.25）。CLL-IPI在CKD（p=0.02）与非CKD患者（p=0.008）中均能实现预后分层。尽管CKD患者B2M>3.5 mg/L的发生率更高（44.1% vs 10.6%，p<0.001），但该指标在该亚组中仍与较差的OS相关（p=0.03）。与CLL-IPI不同，在靶向药物时代（2014-2022年）确诊且可能接受一线治疗的CLL患者中，单独B2M的预后价值仍然显著（p=0.03）。 结论：在合并CKD的早期CLL患者中，B2M仍具有OS预后价值，且有望作为未来预后模型的重要协变量，用于识别靶向药物时代OS高风险患者。

原文链接：

Beta-2-Microglobulin Maintains Overall Survival Prediction in Binet A Stage Chronic Lymphocytic Leukemia Patients with Compromised Kidney Function in Both Treatment Eras of Chemoimmunotherapy and Targeted Agents