RESUMEN
Objectives: The aim of this study was to compare the creatinine equations with cystatin C (CysC) equations to define renal impairment (RI) in newly diagnosed multiple myeloma (MM) patients and to analyse the equation that allows for identifying patients with more and worse prognostic factors. Methods: Renal function was evaluated prospectively in 61 patients with newly diagnosed untreated MM employing CKD-EPI and CAPA equations. The comparison was conducted using Bland-Altman graphics and Cohen's Kappa statistic. Mann-Whitney T and Chi-square tests were used, and univariate and multivariate analyses were carried out. Results: According to the IMWG criteria, 26% of patients showed RI (3 women/13 men) whilst the use of CysC equations allowed us to identify up to 39% of patients (7 women/17 men). The CAPA equation was less biased and dispersed and more sensitive than CKD-EPI-creatinine. Furthermore, univariate analysis unveiled an association between decreased CKD-EPI-CysC and poor prognosis based on R-ISS-3. Conclusions: The IMWG criteria may underestimate kidney disease, mostly in women, which could affect the dose received as well as its toxicity. Altogether, our data suggest that equations that include CysC are more accurate to detect hidden kidney disease, as well as patients with more and worse prognostic factors, in newly diagnosed MM.
RESUMEN
Fundamento y objetivo: El curso clínico de los pacientes con leucemia linfática crónica de células B (LLCB) es extremadamente heterogéneo y no hay índices pronósticos (IP) que permitan clasificar bien a estos pacientes. En este estudio se han analizado 2 nuevos IP propuestos por el MDACC (MD Anderson Cancer Center) y por el grupo GIMEMA (Gruppo Italiano Malattie Ematologiche Maligne dell2 Adulto). Pacientes y método: Se ha realizado un estudio de seguimiento de una cohorte de pacientes diagnosticados de LLCB (265 casos) en el área sanitaria de Gijón durante 10 años (de 1997 a 2007), y de la supervivencia de los pacientes según los sistemas de estadificación clásica (Rai y Binet) y los nuevos IP. Resultados: Las tasas bruta y ajustada fueron de 8,99 y de 3,47 cada 100.000 habitantes por año, respectivamente. El índice GIMEMA no fue útil para predecir la supervivencia global. La distribución según el IP MDACC fue la siguiente: el 31,4% de bajo riesgo, el 62% de riesgo intermedio y el 6,6% de alto riesgo. La probabilidad de supervivencia a los 5 y 10 años fue del 87 y el 73% para el bajo riesgo, del 75 y el 49% para el riesgo intermedio, y del 29 y el 16% para el de alto riesgo. Conclusiones: Las tasas de incidencia de LLCB son superiores a las descritas hasta ahora, posiblemente debido a una mejor recogida de datos y a un diagnóstico más precoz. En este estudio se demuestra por primera vez en una población no seleccionada de pacientes que el IP MDCAA predice mejor la supervivencia que los sistemas de estadificación clásica. Dada su simplicidad, este modelo pronóstico puede ser muy útil para el manejo de los pacientes en la práctica clínica (AU)
Background and objective: The clinical course of B-chronic lymphocytic leukemia (B-CLL) patients is highly heterogeneous and the prognosis of these patients is difficult to predict. In this study, we analysed two new prognostic indexes proposed by the MDACC and GIMEMA group in a random population of B-CCL patients. Patients and methods: A follow up study of a cohort of patients was carried out. 265 B-CLL patients diagnosed in the Area Sanitaria de Gijón during 10 years (1997 2007) were analysed in this study. The overall survival of the patients was analysed by the Rai and Binet staging systems and the prognostic indexes proposed by the MDACC and GIMEMA group. Results: The crude rate was 8.99 per 100.000 populations for year and the adjusted-age rate was 3.47 per 100.000 populations for year. The distribution of patients based on the MDACC index was: 31.4% had low risk, 62% had intermediate risk and 6.6% had high risk. The percentage of 5- and 10-years survival probabilities were 87% and 73% for low risk, 75% and 49% for intermediate risk and 29% and 16% of high risk. The GIMEMA index was unable to predict the overall survival in our patients. Conclusions: he rates of B-CLL are higher in our population than previously described, which is probably caused by an earlier diagnosis. Our results indicate that the MDACC prognostic index predicted the overall survival and the prognosis of a random population of patients better than the classical staging systems. The simplicity and utility of this prognostic index may help clinicians in clinical decision and therapeutical management (AU)
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Leucemia Linfocítica Crónica de Células B/diagnóstico , Pronóstico , Leucemia Linfocítica Crónica de Células B/clasificación , Leucemia Linfocítica Crónica de Células B/epidemiología , Estudios de Seguimiento , Supervivencia sin EnfermedadRESUMEN
BACKGROUND AND OBJECTIVE: The clinical course of B-chronic lymphocytic leukemia (B-CLL) patients is highly heterogeneous and the prognosis of these patients is difficult to predict. In this study, we analysed two new prognostic indexes proposed by the MDACC and GIMEMA group in a random population of B-CCL patients. PATIENTS AND METHODS: A follow up study of a cohort of patients was carried out. 265 B-CLL patients diagnosed in the Area Sanitaria de Gijón during 10 years (1997-2007) were analysed in this study. The overall survival of the patients was analysed by the Rai and Binet staging systems and the prognostic indexes proposed by the MDACC and GIMEMA group. RESULTS: The crude rate was 8.99 per 100.000 populations for year and the adjusted-age rate was 3.47 per 100.000 populations for year. The distribution of patients based on the MDACC index was: 31.4% had low risk, 62% had intermediate risk and 6.6% had high risk. The percentage of 5- and 10-years survival probabilities were 87% and 73% for low risk, 75% and 49% for intermediate risk and 29% and 16% of high risk. The GIMEMA index was unable to predict the overall survival in our patients. CONCLUSIONS: The rates of B-CLL are higher in our population than previously described, which is probably caused by an earlier diagnosis. Our results indicate that the MDACC prognostic index predicted the overall survival and the prognosis of a random population of patients better than the classical staging systems. The simplicity and utility of this prognostic index may help clinicians in clinical decision and therapeutical management.