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Clinical Efficacy of Irradiation in CLL Patients: Predictive Value of in Vitro Radio-induced Apoptosis

In order to identify CLL patients for whom irradiation could be beneficial, we investigated the relationship between in vitro radio-induced apoptosis of leukemic cells and response to low-dose splenic or lymph node radiotherapy. Fourteen patients were included in the in vitro study. Leukemic cells were analyzed by Hoechst staining immediately after collection or 24 h of culture following in vitro irradiation of 0-10 Gy. The tumor response rate was 47% (one CR and six PR), with a mean duration of response of 3 months (range: 1-4). A high correlation between tumor response and in vitro tests was observed (p <0.01) and the positive predictive value of the in vitro tests for tumor and hematological responses was 100% at 5 Gy. These results suggest that the sensitivity of leukemic cells to irradiation should be first evaluated in an in vitro assay to spare refractory patients from the useless toxicity radiotherapy.