Leukemia https://doi.org/10.1038/s41375-020-0833-x LETTER Chronic lymphocytic leukemia Survival risk score for real-life relapsed/refractory chronic lymphocytic leukemia patients receiving ibrutinib. A campus CLL study Massimo Gentile 1,2 ● Fortunato Morabito 2,3 ● Giovanni Del Poeta 4 ● Francesca Romana Mauro 5 ● Gianluigi Reda 6 ● Paolo Sportoletti 7 ● Luca Laurenti 8 ● Marta Coscia 9 ● Yair Herishanu 10 ● Anna Grazia Recchia 2 ● Marzia Varettoni 11 ● Roberta Murru 12 ● Annalisa Chiarenza 13 ● Adalgisa Condoluci 14 ● Riccardo Moia 15 ● Daniela Pietrasanta 16 ● Giacomo Loseto 17 ● Ugo Consoli 18 ● Ilaria Scortechini 19 ● Francesca Maria Rossi 20 ● Antonella Zucchetto 20 ● Vincenzo Fraticelli 1,2 ● Ernesto Vigna 1,2 ● Cirino Botta 1,2 ● Giovanni Tripepi 21 ● Graziella D’ Arrigo 21 ● Angela Rago 22 ● Ilaria Angeletti 23 ● Annalisa Biagi 4 ● Ilaria Del Giudice 5 ● Riccardo Bomben 20 ● Gian Matteo Rigolin 24 ● Davide Rossi 14 ● Francesco Di Raimondo 13 ● Gianluca Gaidano 15 ● Aaron Polliack 25 ● Antonio Cuneo 24 ● Robin Foà 5 ● Valter Gattei 20 Received: 14 November 2019 / Revised: 25 March 2020 / Accepted: 6 April 2020 © Springer Nature Limited 2020 To the Editor: Nowadays, the identification of prognostic models for overall survival (OS) prediction specifically applicable in relapsed/refractory chronic lymphocytic leukemia (R/R CLL) in treatment with the novel target drugs may represent an important goal of clinical research on CLL. Recently, a retrospective pooled cohort study based on an international collaboration collected information from ~2500 R/R CLL patients treated either with chemo- immunotherapy or new drugs (ibrutinib, idelalisib, or venetoclax) and proposed a comprehensive risk score for the OS prediction, based on four widely accessible para- meters (i.e., β2-microglobulin, anemia, LDH, last therapy, a.k.a. BALL score) [1]. Although this score may represent an easy “globally applicable” model to be used in the daily clinical practice in order to improve risk stratifica- tion in all R/R CLL patients, its validation in the setting of ibrutinib, which in the clinical practice represents the most used drug in R/R patients, is still lacking. In the present study, from an institutional Italian mul- ticenter working group on CLL (“Campus CLL”), we developed a weighted, multivariate score [survival risk score for ibrutinib (SRS I )] for OS prediction by integrating clinical, laboratory, and biological parameters, as eval- uated at the time of ibrutinib initiation in an independent cohort of R/R CLL patients who received ibrutinib 420 mg/day outside of clinical trials as salvage therapy and compared this new score with the BALL score in our cohort (Supplementary Table 1). CLL databases from 18 Italian, 1 Swiss, and 1 Israeli centers were established for research purposes. Overall, 541 CLL patients were included in this analysis. The majority of patients were Binet stages B and C (87.2%). The median age was 70.4 years (range 37–88) and 353 cases (65.2%) were male. The median number of previous therapies was 2 (range 1–9). Furthermore, 120 patients discontinued ibrutinib for toxicity, 60 for CLL progres- sion and 24 for Richter transformation. The baseline patients’ features are listed in Supplementary Table 2. After a median follow-up of 1.8 years (range 1 month to 5.8 years), 101 patients had died. To identify a SRS I for R/R ibrutinib-treated CLL, we moved from a univariable analysis that included sex, age, hemoglobin levels, Binet stage, β2-microglobulin and LDH levels, time from last therapy, IGHV mutational status, and 17p deletion. A multivariate analysis was then carried out on parameters significantly associated with OS. Finally, factors independently associated with OS were included in the SRS I (Table 1). Similar results were * Massimo Gentile massim.gentile@tiscali.it * Valter Gattei vgattei@cro.it Extended author information available on the last page of the article Supplementary information The online version of this article (https:// doi.org/10.1038/s41375-020-0833-x) contains supplementary material, which is available to authorized users. 1234567890();,: 1234567890();,: