Chronic lymphocytic leukemia: diagnostic profile and treatment outcomes

Abstract

Introduction: Chronic lymphocytic leukemia (CLL) is the most common chronic leukemia within the structure of morbidity by hematological malignancies. The increased rates of morbidity and disability, frequent relapses, immune and infectious complications identify CLL as an actual concern of hematologic oncology. Methods: Our clinico-analytical, descriptive study comprised 82 patients with CLL, who were treated and followed up the Institute of Oncology during 2014 – 2020. The age range was 45-86 years (median age – 66.2 years old). There were 47 (57.3%) males and 35 (42.7%) females. The diagnosis was proved by histopathological, immunohistochemical, cytological and immunophenotyping examinations of the bone marrow and biopsied lymph nodes. The stage of CLL was established according to Binet Classification. Stage A disease didn’t require chemotherapy until progression. Single-agent chemotherapy with chlorambucil and rituximab were administered in patients with stage B of CLL. Patients, who evolved into stage C, were managed with combined chemotherapy (COP, CHOP) and radiotherapy. Results: CLL occurred in 56 (68.2%) patients with the age between 60-79 years. CLL was diagnosed in 68 (82.9%) cases in the first 6 months after the disease onset. The median disease span from the onset till diagnosis was 4.2 months. Stage A was revealed at diagnosis in 54 (65.9%) patients, and stage B – in 28 (34.1%). The disease evolved from stage A into stage B in 22 (40.8%) cases, and from stage B into stage C in 10 (12.1%). Of 54 patients with stage A, 22 (40.7%) did not experience any clinical signs of CLL at diagnosis. In stage B peripheral lymph node enlargement was observed in 27 (96.4%) cases, splenomegaly – in 22 (78.6%), and hepatomegaly – in 13 (46.4%). Richter syndrome developed in 11 (39.3%) cases with stage C. In stage B disease, autoimmune hemolytic anemia occurred in 9 (32.1%) patients, metaplastic anemia – in 13 (46.5%), autoimmune thrombocytopenia – in 5 (17.9%). Infections at diagnosis were registered in 11 (20.4%) cases with stage A and in 9 (32.1%) with stage B, numbering totally 36 (43.9%) cases. Leukocyte count ranged between 10.8-525 x 1000 [MICRO]/L, (median – 93.7 x 1000 [MICRO]/L), and lymphocyte count – between 51-97% (median – 76.2%). Single-agent chemotherapy with chlorambucil was administered in 22 (40.8%) patients with comorbidities, who evolved from stage A into stage B, and in all patients with stage B at diagnosis. Only partial responses had been achieved. In the totality of patients, the overall survival at one year constituted 98.0%, 3 years – 91.2%, 5 years – 77.4%. Conclusions: In our study CLL affected mostly males and elderly persons of 60-79 years old. The majority of patients were diagnosed with stage A. Autoimmune hemolytic anemia and infections turned out to be the relatively frequent complications of CLL. The overall survival depended on CLL stage, and proved to be comparably increased under the combined treatment.