Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The International Prognostic Index for Chronic Lymphocytic Leukemia (CLL-IPI) is a tool designed to evaluate a patient's risk profile based on several clinical parameters. This risk assessment is done by calculating a total score from a set of patient data inputs and subsequently interpreting this score to project the patient’s 5-year survival probability.

To compute the risk score, the following patient characteristics are assessed:

- Age: 
  - Patients aged 65 years or younger receive a score of 0.
  - If a patient is older than 65 years, they receive a score of 1.

- Clinical Stage: 
  - A clinical stage of Binet A or Rai 0 scores 0.
  - A clinical stage of Binet B-C or Rai I-IV scores 1.

- Serum β2 Microglobulin Level (mg/L): 
  - Levels at or below 3.5 mg/L are scored as 0.
  - Levels above 3.5 mg/L receive a score of 2.

- IGHV Mutational Status:
  - Mutated IGHV is given a score of 0.
  - Unmutated IGHV is given a score of 2.

- TP53 Status:
  - If there are no abnormalities, the score is 0.
  - If there is a deletion 17p (detected via FISH) and/or a TP53 mutation (detected via sequencing), the score is 4.

Each characteristic contributes to a total risk score by adding up the specified scores for the categories that apply to the patient's data. The resulting score places the patient into one of four risk groups, providing crucial prognostic information:

- A total score of 0-1 indicates a low-risk group. Patients in this category have a projected 5-year survival rate of 93.2%.
- A total score of 2-3 indicates an intermediate-risk group, with a 5-year survival rate of 79.3%.
- A total score of 4-6 suggests a high-risk group, forecasting a 63.3% 5-year survival rate.
- A total score of 7-10 places the patient in a very high-risk group, with a significantly lower 5-year survival rate of 23.3%.

This risk assessment offers patients and healthcare providers valuable insights into patient prognosis based on specific clinical and genetic factors of chronic lymphocytic leukemia.

The calculator in question is the International Prognostic Index for Chronic Lymphocytic Leukemia, abbreviated as CLL-IPI. This scoring system is specifically designed for patients diagnosed with Chronic Lymphocytic Leukemia (CLL). The CLL-IPI is used to predict the prognosis of CLL patients, helping clinicians to stratify patients into different risk groups and guide treatment decisions. 

The CLL-IPI incorporates five variables: age, clinical stage, TP53 status, IGHV mutational status, and serum beta-2 microglobulin level. Each of these variables is assigned a score, and the total score determines the risk category (low, intermediate, high, or very high risk).

There are no specific exclusion criteria for the use of the CLL-IPI. However, it may not be as accurate in patients with rare or unusual presentations of CLL, or in patients with insufficient data to calculate all five variables.

International prognostic index for chronic lymphocytic leukemia (CLL-IPI)

The Eastern Cooperative Oncology Group (ECOG) performance status calculator is designed to evaluate a patient's functional ability and categorize it into a specific score from 0 to 5. This quantitative measure helps clinicians make informed decisions about treatment based on the patient's capacity for daily activities and self-care. Here's how it operates:

The user provides input by selecting the description that best matches the patient's current condition from a list of predefined options. These options encapsulate various levels of activity and ability:

- A patient who is "Fully active, able to carry on all pre-disease performance without restriction" is assigned a score of ECOG PS 0. This indicates that the patient is not limited in any capacity by their disease.
- If a patient is "Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, such as light housework, office work," they receive an ECOG PS 1. This means the patient can perform some self-care and work activities but faces restrictions with strenuous tasks.
- "Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours" corresponds to an ECOG PS 2. This reflects moderate impairment, where the patient is active for the majority of the day but not capable of work activities.
- A patient who is "Capable of only limited self-care, confined to bed or chair more than 50% of waking hours" gets an ECOG PS 3. This score denotes significant limitation, as the patient is mobile for less than 50% of the time and requires assistance for most activities.
- With "Completely disabled, cannot carry on any self-care, totally confined to bed or chair," the patient is categorized as ECOG PS 4, indicating severe impairment and complete dependency.
- Finally, if the patient is "Dead," they are assigned an ECOG PS 5.

These score assignments help standardize assessments, providing an objective measure of a patient's status which can be pivotal in guiding medical decisions and evaluating treatment options.

The Eastern Cooperative Oncology Group (ECOG) performance status, also known as the ECOG score, is a widely used tool in oncology to assess a patient's level of functioning in terms of their ability to care for themselves, daily activity, and physical ability (walking, working, etc.). It is applicable to patients with cancer of any type and at any stage.

The ECOG score ranges from 0 to 5, with 0 indicating fully active and able to carry on all pre-disease activities without restriction, and 5 indicating death. The score is used to determine a patient's prognosis, assess how a disease is progressing, and to determine appropriate treatment strategies. It is also often used in clinical trials to assess eligibility and to monitor patient progress.

There are no specific exclusion criteria for the use of the ECOG score, but it is important to note that it is a subjective measure and may not fully capture a patient's functional status. It is also less useful in patients with fluctuating or rapidly changing conditions.

Eastern Cooperative Oncology Group performance status (ECOG score)

The Karnofsky Performance Scale (KPS) provides a practical method to evaluate a patient's functional ability and the extent of care required based on their health status. The scale ranges from 0% to 100%, where higher percentages signify better functional capacity and health.

This tool involves selecting a descriptive statement that best reflects a patient's current condition from a predefined list. Each statement is connected to a specific KPS percentage that indicates the patient’s ability to perform daily activities and their dependency levels. Here’s how the assessment works:

- When a patient is described as "Normal, no complaints, no evidence of disease," this is assessed as KPS 100%. At this level, the individual can engage in all regular activities, including work, without needing special care.

- If a patient can "carry on normal activity" but exhibits "minor signs or symptoms of disease," they are scored at KPS 90%, indicating the capability to maintain routine activities without requiring special care.

- A description of "Normal activity with effort, some signs or symptoms of disease" aligns with KPS 80%. This suggests the patient can still carry out normal activities but might require some extra effort.

- When the condition reflects "Cares for self, unable to carry on normal activity or to do active work," it corresponds to KPS 70%. The patient can handle most personal needs independently but may need occasional assistance.

- "Requires occasional assistance but is able to care for most personal needs" is rated as KPS 60%, implying increased dependency on assistance though the patient remains mostly self-sufficient.

- At KPS 50%, for conditions described as "Requires considerable assistance and frequent medical care," the patient can live at home but needs considerable help with personal care.

- As the need for care intensifies, with descriptions like "Disabled, requires special care and assistance," the KPS drops to 40%. This marks a significant deterioration in self-care ability.

- "Severely disabled, hospital admission is indicated, death not imminent" corresponds to KPS 30%, highlighting a need for hospitalization without immediate life-threatening conditions.

- For those "Very sick," necessitating hospital admission and "active supportive treatment," the KPS is 20%, indicating critical care requirements.

- At KPS 10%, "Moribund" denotes an inability to care for oneself, with urgent need for hospital-level care and a poor prognosis.

- Lastly, "Dead" is considered as KPS 0%.

This scale is instrumental in providing a quick overview of a patient's ability to function independently and their need for medical support, thereby facilitating better care planning and resource allocation.

The Karnofsky Performance Status Scale (KPSS) is a clinical calculator used primarily in patients with cancer. It is a simple, numerical scale that measures a patient's functional status, ability to perform daily activities, and overall quality of life. The KPSS ranges from 0 (indicating death) to 100 (indicating perfect health). 

The clinical utility of the KPSS is to assess a patient's prognosis, determine appropriate treatment strategies, and monitor changes in a patient's condition over time. It is particularly useful in oncology for determining eligibility for certain treatments, such as chemotherapy or surgery, and for predicting survival outcomes. 

There are no specific exclusion criteria for the use of the KPSS. However, it is less useful in patients with non-cancer illnesses or in those with cognitive impairment who may not be able to accurately self-report their functional status.

Karnofsky Performance Scale

The Modified Glasgow Prognostic Score (mGPS) is a key tool in predicting cancer outcomes, relying on the assessment of two biochemical markers: C-reactive protein (CRP) and albumin. This score helps to categorize the prognosis into three levels: good, intermediate, and poor.

To compute the mGPS:

- C-reactive protein is evaluated first. Two options are considered:  
  - If the CRP is less than or equal to 10 mg/L, it indicates lower systemic inflammation.
  - If the CRP is greater than 10 mg/L, it signifies higher inflammation levels.

- Albumin is the second marker, with two possibilities:  
  - An albumin level of less than 3.5 g/dL [35 g/L] suggests malnutrition or potential inflammatory conditions.
  - An albumin level equal to or greater than 3.5 g/dL [35 g/L] signifies a normal nutritional status and protein reserves.

The mGPS score is derived based on the following systematic interpretation:

- If CRP is <= 10 mg/L, regardless of the albumin level, the score is mGPS 0, corresponding to a good prognosis. This combination indicates a low level of inflammation, which is a favorable signal in cancer outcomes.
 
- If CRP is > 10 mg/L and albumin is >= 3.5 g/dL [35 g/L], the score is mGPS 1, associated with an intermediate prognosis. This combination suggests elevated inflammation yet with sufficient nutritional status, resulting in a moderate outlook.

- If CRP is > 10 mg/L and albumin is < 3.5 g/dL [35 g/L], the result is mGPS 2, indicating a poor prognosis. This reflects high inflammation levels coupled with low albumin, suggesting a more severe condition.

Here's a concise summary table for reference:

| C-reactive Protein | Albumin               | mGPS Score | Interpretation          |
|---------------------|-----------------------|-------------|-----------------------|
| <= 10 mg/L          | < 3.5 or >= 3.5 g/dL  | 0           | Good prognosis         |
| > 10 mg/L           | >= 3.5 g/dL           | 1           | Intermediate prognosis |
| > 10 mg/L           | < 3.5 g/dL            | 2           | Poor prognosis         |

This systematic approach enables healthcare providers to improve risk stratification in cancer patients, allowing for more tailored treatment planning.

The Modified Glasgow Prognostic Score (mGPS) is a clinical calculator used in the field of oncology to predict the prognosis of patients with cancer. It is applicable to a wide range of cancer types and stages, making it a versatile tool for clinicians. The mGPS is based on two simple, routinely measured inflammatory markers: C-reactive protein (CRP) and albumin levels. 

The clinical utility of the mGPS lies in its ability to stratify patients into different risk groups based on their inflammatory response to cancer. This can guide clinicians in making decisions about treatment strategies and follow-up plans. It can also provide valuable prognostic information to patients and their families.

There are no specific exclusion criteria for the use of the mGPS. However, it should be noted that the score may not be as accurate in patients with concurrent inflammatory or infectious conditions, as these can also affect CRP and albumin levels. Additionally, the mGPS may not be applicable to patients with rare types of cancer or those with very early or very advanced disease, as it has not been extensively validated in these groups.

Modified Glasgow Prognostic Score for cancer outcomes (mGPS)

Chronic lymphocytic leukemia

Management of relapsed/refractory disease

Cytogenetic analysis

Management of infection

Stem cell transplantation

Stem cell transplantation (management of non-donor-specific anti-HLA antibodies)

Patients with Richter's transformation

Patients with Richter's transformation, stem cell transplantation

Management of hypogammaglobulinemia

Management of cytopenias

Differential diagnosis

Patients with Richter's transformation, biopsy

Biopsy

Laboratory testing

Surveillance for malignancy

Initial treatment

Indications for screening

Screening for viral infections

Patients with autoimmune hemolytic anemia or immune thrombocytopenia

Routine immunizations

Patients with CMV infection

Diagnostic criteria

Chimeric antigen receptor therapy

CAR therapy

Patients with Richter's transformation (screening for viral infections)

History and physical examination

Patients with Richter's transformation, systemic therapy

Diagnostic imaging

Watchful waiting

Indications for treatment

Antimicrobial prophylaxis

Stem cell transplantation (management of donor-specific anti-HLA antibodies, desensitization therapy)

Stem cell transplantation, indications

Patients with Richter's transformation (mutational analysis)

Patients with Richter's transformation (palliative care)

Patients with Richter's transformation (enrollment in clinical trials)

Management of tumor lysis syndrome

Stem cell transplantation (management of donor-specific anti-HLA antibodies, follow-up)

Assessment of treatment response

Patients with COVID-19 infection

Stem cell transplantation (management of donor-specific anti-HLA antibodies, prevention)

Patients with chronic hepatitis B or C

Stem cell transplantation (management of donor-specific anti-HLA antibodies, testing)

Updated 2024 ESMO guidelines for targeted therapy in first-line treatment and relapse of chronic lymphocytic leukemia


Chronic lymphocytic leukemia

Background

Overview

Guidelines

Key sources