Evaluation of general clinical features and treatment response in chronic lymphocytic leukemi̇a patients

Objective: Chronic Lymphocytic Leukemia (CLL) is a lymphoproliferative disorder with variable clinical features and mostly occurs at advanced ages but may be seen at younger ages. In addition to using traditional prognostic factors for optimal detection of risk status and prognosis in CLL patients, new prognostic factors and scoring systems are being investigated recently. Significant improvements in survival and mortality rates are observed with new drugs and treatment regimens. In this study, we aimed to determine the efficacy of prognostic factors in detection of prognosis and risk status and efficiacy of treatment regimens on survival and mortality in patients with CLL diagnosis. Materials and Methods: In this study 131 CLL patients who were followed-up between January 2006 and January 2018 in Van Yuzuncu Yil University Faculty of Medicine, Hematology Clinic were evaluated retrospectively. The relationship of mortality, treatment free survival (TFS) and overall survival (OS) and clinical and laboratory characteristics, flow cytometry (CD38 and CD5) analysis, cytogenetic (del (17p), del(11q)) analysis, bone marrow involvement patterns, lactate dehydrogenase (LDH) levels, β2 (beta2) microglobulin levels and treatment response status was analysed. Results: Male/female ratio was 2,5/1, the median age was 62 and %25 of patients were individuals under 55 years of age.73.3% of patients were alive. In the mortality analysis, age >64, hemoglobin level ≤13.8 g/dL, thrombocyte level ≤130000/mcL, albumin level ≤4.1 g/dL, high LDH level, hepatosplenomegaly, presence of B symptoms found to be releated with increased mortality. Univariate survival analysis showed that age > 64, hemoglobin level ≤13.8 gr/dL, thrombocyte level ≤130000/mcL, albumin level ≤4.1 g/dL, high LDH level, hepatosplenomegaly, presence of B symptoms significantly shortened the treatment-free survival (TFS). Hemoglobin level ≤13.8 g/dL, platelet level ≤130000/mcL, albumin level ≤4.1 g/dL, high LDH level, hepatosplenomegaly and presence of B symptoms were found to be factors that shortened the overall survival (OS) significantly. Mortality was found to increase, on the other hand treatment-free survival and overall survival was found to decrease significantly as the Rai, modified Rai and Binet stage increased. In a Cox multivariate model, factors that independently predicted treatment-free survival were age (≤64), Binet stage (stage A and B), factors that independently predicted the overal survival were age (≤64), Binet stage (stage A and B) and presence of B symptoms.In a Cox multivariate model excluding the stage, factors that independently predicted treatment-free survival were age (≤64), albumin level (> 4,1 g/dL) and absence of B symptoms, hepatomegaly and AIHA while factors that independently predicted overal survival were age (≤64), albumin level (> 4.1 g / dL), and absence of hepatomegaly. There was a significant relationship between treatment regimes other than FCR regimen and increased mortality. When the relationship between treatment response and mortality was examined, mortality was found to increase significantly in patients who did not respond to first or second line therapy or had progression (R). The number of chemotherapy cycles received by the patients in the first line chemotherapy ≤4, in the second line chemotherapy ≤2 were found to increase the mortality and to shorten the overall survival significantly. Conclusion: Optimal evaluation can be done by determining the prognosis and risk status of the patients with CLL diagnosis and mortality is decreased by giving the FCR regimen for an optimal duration in patients who have no contraindication and who can tolerate the treatment.