Prognostic impact of renal insufficiency (RI) at diagnosis in patients with chronic lymphocytic leukemia (CLL).

7084 Background: Renal function has a well-established prognostic role in patients with some hematological malignancies, such as multiple myeloma. However, its impact on survival in patients with CLL hasn’t been explored. Methods: We used the Mayo Clinic CLL database to identify all patients diagnosed with CLL between 01/1995 and 11/2014 using the 2009 iwCLL criteria and seen at our center prior to treatment. Patients for whom we could not calculate a baseline creatinine clearance (Cr-Cl) due to missing creatinine/weight or who were missing baseline complete blood count (CBC) (n = 466) were excluded from final analysis. Renal insufficiency (RI) was defined as Cr-Cl < 45 mL/min calculated with the Cockroft-Gault equation. Logistic regression was used to determine which factors predicted RI. Fisher’s exact test was used to compare treatment types by RI. The Kaplan-Meier method was used for the survival analyses. Results: The final analysis included 1268 patients. Of these, 87 (7%) had RI at diagnosis. Factors significantly associated with RI on univariate analysis (UVA) were age > 65 years, female sex, hypertension (HTN), hemoglobin < 11 g/dL, and Rai stage III-IV. Factors associated with RI on multivariate analysis (MVA) were age > 65 years, female sex, HTN, and advanced Rai stage. Of the 506 patients who required treatment, 25 had RI. Type of first treatment differed between patients with and without RI (p < 0.001); patients with RI were more likely to receive alkylator-based therapy (48% vs 15%) and less likely to receive purine analogue-based CIT (8% vs 44%). Median overall survival (OS) was 124 months, 59 months for those with RI, 132 months for those without RI (p < 0.001). Baseline characteristics (age, sex, HTN, diabetes, CBC, CD49d, CD38, ZAP70, IGHV mutation status and FISH) as well as RI were associated with OS on UVA. Conclusions: RI is relatively frequent at time of CLL diagnosis (7% of cases) and has a profound influence on therapy selection among patients requiring treatment. RI at time of CLL diagnosis is associated with overall survival.