Examination of the need for treatment and the variables affecting survival in patients with chronic lymphocytic leukemia without indication for treatment at admission
Examination of the need for treatment and the variables affecting survival in patients with chronic lymphocytic leukemia without indication for treatment at admission
Aim: To evaluate the clinical features of patients with early-stage chronic lymphocytic leukemia (CLL) without any indication for treatment, and to examine the effects of features recorded during diagnosis on the need for treatment and the predictability of survival without treatment. Materials and Methods: This study was conducted by retrospectively evaluating the files of 53 patients with early-stage CLL who attended follow-up in the hematology outpatient clinic of Okmeydanı Training and Research Hospital, between 2000 and 2019, and who had no indication for treatment at the time of diagnosis. The sociodemographic characteristics of the patients, blood values recorded at diagnosis, physical examination findings, disease stage (Binet and Rai staging), immunophenotypic findings, and treatment characteristics were examined. Results: Of the 53 patients whose results were evaluated, 28 (52.8%) were women and the mean age was 62.96 ± 9.30 years. According to the Binet staging at the time of diagnosis, 43 (81.1%) patients were Binet A and 10 (18.9%) were Binet B. According to Rai staging, 22 (41.5%) patients were Rai 0, 19 (35.8%) were Rai 1 and 12 (22.6%) patients were Rai 2. Treatment was required in 10 (18.9%) patients during follow-up. The leukocyte count and lymphadenopathy count of the patients who received treatment were significantly higher (p = 0.022, p = 0.007, respectively). Twenty-two (51.2%) patients who did not receive treatment were Rai 0; there was no patient with Rai 0 among those who received treatment. Multivariable logistic regression analysis was performed to determine significant parameters associated with receiving treatment, and Rai stage (OR: 4.683, 95% CI: 1.548-14.172, p = 0.006) was found to be significant. Survival without treatment was not associated with sex, age, splenomegaly, hepatomegaly, lymphadenopathy, Binet stage, Rai stage, and CD38-positivity (p > 0.05). Conclusion: In patients with early-stage CLL who do not need treatment at the time of diagnosis, possible need for treatment may be associated with Rai stage.
___
- 1. Frezzato F, Trimarco V, Visentin A, et al. Targeting Brutons Tyrosine Kinase in Chronic Lymphocytic Leukemia at the Crossroad between Intrinsic and Extrinsic Pro-survival Signals. J Leuk 2016;4:1
- 2. Sagatys EM, Zhang L. Clinical and laboratory prognostic indicators in chronic lymphocytic leukemia. Cancer Control 2012;19:18-25
- 3. Robak T. Staging and prognostic factors in chronic lymphocytic leukemia: Current status. J Leuk 2014;2:5.
- 4. Molica S. Sex differences in incidence and outcome of chronic lymphocytic leukemia patients. Leuk Lymphoma 2006;47:1477-80
- 5. Watson L, Wyld P, Catovsky D. Disease burden of chronic lymphocytic leukaemia within the European Union. Eur J Haematol 2008;81:253-8
- 6. Döhner H, Stilgenbauer S, Benner A, et al. Genomic aberrations and survival in chronic lymphocytic leukemia. N Engl J Med 2000;343:1910-6
- 7. Binet JL, Auquier A, Dighiero G, et al. A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer 1981;48:198-206
- 8. Rai KR, Sawitsky A, Cronkite EP, et al. Clinical staging of chronic lymphocytic leukemia. Blood 1975;46:219–234
- 9. Eichhorst B, Robak T, Montserrat E, et al. Chronic lymphocytic leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015;26 Suppl 5:v78-84
- 10. Amaya-Chanaga CI, Rassenti LZ. Biomarkers in chronic lymphocytic leukemia: Clinical applications and prognostic markers. Best Pract Res Clin Haematol 2016;29:79-89
- 11. Foà R, Del Giudice I, Guarini A, et al. Clinical implications of the molecular genetics of chronic lymphocytic leukemia. Haematologica 2013;98:675-85
- 12. Gribben JG. How I treat CLL up front. Blood 2010;115:187-97
- 13. Wierda WG, Byrd JC, Abramson JS, et al. Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, Version 4.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020;18:185-217
- 14. Redaelli A, Laskin BL, Stephens JM, et al. The clinical and epidemiological burden of chronic lymphocytic leukaemia. Eur J Cancer Care (Engl) 2004;13:279-87
- 15. Wierda WG, O’brien S, Wang X, et al. Prognostic nomogram and index for overall survival in previously untreated patients with chronic lymphocytic leukemia. Blood 2007;109:4679-85
- 16. Shanafelt TD, Geyer SM, Kay NE. Prognosis at diagnosis: integrating molecular biologic insights into clinical practice for patients with CLL. Blood 2004;103:1202-10
- 17. Letestu R, Lévy V, Eclache V, et al. Prognosis of Binet stage A chronic lymphocytic leukemia patients: the strength of routine parameters. Blood 2010;116:4588-90
- 18. Demir V, Kahraman S, Katgi A, et al. Kronik lenfositik lösemi hastalarının genel klinik degerlendirilmesi. Dokuz Eylül Üniversitesi Tıp Fakül- ˘ tesi Dergisi 2012;26:9-19
- 19. Kumar V, Ailawadhi S, Bojanini L, et al. Trends in the risk of second primary malignancies among survivors of chronic lymphocytic leukemia. Blood Cancer J 2019;9:75