Originally published as JCO Early Release 10.1200/JCO.2007.12.1152 on November 5 2007

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Computed Tomography Scans Do Not Improve the Predictive Power of 1996 National Cancer Institute–Sponsored Working Group Chronic Lymphocytic Leukemia Response Criteria

Kristie A. Blum, Donn Young, Sarah Broering, Margaret S. Lucas, Beth Fischer, Thomas S. Lin, Michael R. Grever, John C. Byrd

From the Division of Hematology-Oncology, Department of Internal Medicine; Biostatistical Core, The Arthur G. James Comprehensive Cancer Center; and the Division of Medicinal Chemistry and Pharmacology, College of Pharmacy, The Ohio State University, Columbus, OH

Address reprint requests to Kristie A. Blum, MD, The Ohio State University, Division of Hematology-Oncology, Starling Loving Hall, Room B324, Columbus, OH 43210; e-mail: kristie.blum{at}osumc.edu

Purpose: National Cancer Institute–sponsored Working Group (NCI-WG) response criteria for chronic lymphocytic leukemia (CLL) rely on physical examination, blood, and bone marrow evaluations. The widespread use of computed tomography (CT) scans has prompted many to advocate for the incorporation of this test into CLL response criteria.

Patients and Methods: In a retrospective review of 82 CLL patients treated at the Ohio State University (Columbus, OH), we compared CT assessed response using non-Hodgkin's lymphoma (NHL) response definitions with NCI-WG response.

Results: Responses by NCI-WG criteria included five complete responses (CRs), 32 partial responses (PRs), 21 patients with stable disease (SD), 17 patients with progressive disease (PD), and seven patients not assessable (NA). Responses by NHL-CT criteria included three CRs, 12 unconfirmed CRs (CRus), 16 PRs, 26 with SD, four with PD, and 21 NA. Using NCI-WG criteria, progression-free survival (PFS) was 27.3 months for CR and 11.4 months for PR. With NHL-CT criteria, PFS was 18.4 months for CR, 11.7 months for CRu, and 14.5 months for PR. In multivariate analysis, both NCI-WG and NHL-CT response correlated with PFS (P = .009 and .001, respectively).

Conclusion: Current NCI-WG CLL response criteria are a significant predictor of PFS in previously treated CLL patients, with no additional benefit from the inclusion of CT scans. Although retrospective, these results highlight the importance of prospective validation of CT scans before routine inclusion in CLL response criteria.

published online ahead of print at www.jco.org on November 5, 2007.

Supported by Grants No. K23 CA109004-01A1, U01 CA 76576, R21 CA112947-01A1, National Cancer Institute P01 CA95426, Specialized Center for Research from the Leukemia and Lymphoma Society P30 CA16058, and the D. Warren Brown Foundation.

Presented in part as a poster presentation at the 48th Annual Meeting of the American Society of Hematology, December 10, 2007, Orlando, FL.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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