Evaluation of factors influencing on the time from diagnosis to the indication of treatment in patients with chronic lymphocytic leukemia

Objective: Chronic lymphocytic leukemia (CLL) is a slowly progressing condition which won't need treatment indication around all patients. In this work, we aimed to inspect the demographics, cytogenetics, flow cytometrics, laboratory results; physical examinations and and radiological findings of patients of Balcalı Hospital of Çukurova University Medical Faculty and Adana City Hospital to do a research on retrospective effects of these aforementioned reviewed findings from diagnosis to indication of treatment. Method: Age, sex, hemogram values, biochemical values, Ig levels, presence of 17p deletion, flow cytometric markers, the size of the largest lymph node, DAT levels, splenomegaly/hepatomegaly presence of 144 Chronic lymphocytic leukemia patients who applied to, and have their conditions tracked by Hematology Department of Çukurova University Medical Faculty and Adana City Training and Research Hospital between 2010-2022 are reviewed retrospectively and then registered. RAI stagings are performed at the time of diagnosis in patients. The effect of these results on the time from diagnosis to indication of treatment is analyzed. Results: The mean age of the patients 63,6 and 80 (%55,6) were male. Male/female ratio was 1,25/1. 17p deletion was determined in 16 patients (%11.1), hepatomegaly in 54 patients (%37.5), splenomegaly in 67 patients (%46.5), and lymphadenopathy in 119 patients (%82.6). D. Coombs positivity was found 16 (%11,1) of patients. Treatment period (in months) was below the average in pateints with 17p deletion, hepatomegaly, splenomegaly (respectively p=0,039; p=0,041; p=0,028). A signifcant difference was observed between RAI stage and treatment period findings (p<0,001). The study found weak negative (opposite) correlations between LDH (u/l), CD19, and the largest lymph node size values (r=-0.239, r=-0.239, and r=-0.190, respectively) and the duration of treatment-free time. Additionally, moderate negative (opposite) correlations were observed between the duration of treatment-free time and Wbc and lymphocyte values (r=-0.308 and r=-0.307, respectively). On the other hand, weak positive (linear) correlations were found between the duration of treatment-free time and Platelet, Albumin/Total Protein, IGM (mg/dl), and IGA (mg/dl) values (r=0.273, r=0.244, r=0.240, and r=0.261, respectively). Discussion and Conclusion: It was obeserved that the treatment-free time is shorter around the patients with 17p deletion or high lymphocite count or high level LDH. Also a positive relation was determined between Ig levels and the treatment-free time. The RAI stage which is the most important factor in CLL prognosis was identified that it is affecting the treatment-free time aswel. Longer treatment-free time durations was observed in lower RAI stages. As it was anticipated, as a part of the RAI staging a sooner treatment start was observed in the patients with splenomegaly/hepatomegaly. Determining the factors that affect the treatment-free time in CLL patients will also be beneficial in terms of predicting the prognosis of the disease and identifying patients who will require early treatment and monitoring. There is a need for larger and more extensive studies on this topic. Keywords: Chronic lymphocytic leukemia, prognosis, treatment free time