General clinical evaluation of the chronic lymphocytic leukemia

OBJECTIVE: CLL is a hematologic malignancy characterized by abnormal accumulation of mature B lymphocytes in periferal blood, bone marrow and lenfoid tissues. Demographic features, treatment endications, responds to treatment of 114 patients observed in years of 2000-2011 on hematology department of Dokuz Eylül University Medical Faculty have been analized in our study.METHODS: Features of 114 CLL patients were evaluated retrospectively. National Cancer Institude Working Groupe criteria were accepted for disease diagnosis. Also treatment endications and respons to treatment were evaluated according to these criteria.RESULTS: 114 patients observed by hematology department of Dokuz Eylül University Medical Faculty were included in the study. In total 60 patients were male(%52,6) and 54 patients were female(%47,4). They were between the ages of 28 and 87; the average age was 68,24. While 61 patients were being observed without treatment, 53 patients were under medical treatment. The number of the patients under treatment was found out to be increased on Rai medium risk group or Binet stage B. The therapy free survival time was 15,57 months in average. Chlorambucil was the most prefered drug on the first line therapy(%62) and the most frequent treatment endication was systemic symptom. In the evaluation which was held at the end of the patients first line chemotherapy; partial remission for 40 patients, complete remission for 5 patients, stable disease for 7 patients and progression for 1 patient was observed. Also progression free survival time was found to be 18 months. 25 patients have second line therapy. At the end of chemotherapy for those patients; complete remission for 1 patient, partial remission for 20 patients, stable disease for 1 patient was observed and there was progression in 3 patients. The progression free survival average of the second line therapy was 6,23 months. On the other side; the third line therapy was given to 6 patients and the progression free survival average of the third line therapy was 5,5 months. At the end of the study overall survival of 114 patients was 92,8 months in average. It was seen that 10 patients had autoimmune hemolytic anemia, 12 patients had immune thrombocytopenic purpura and 6 of them had Evans Syndrome. Also there was second malignancy on 12 patients. For the patients who has positiveness of CD38, autoimmune hemolytic anemia and immune thrombocytic purpura, overall survival time was shorter. There was positive corelation between CD23 and overall survival time(p<0,05). It was concluded that for the patients whose Rai and Binet stage is high, therapy free survival and progression free survival 1 time is shorter(p<0,05). But there was no correlation between staging and overall survival time. The overall survival time for the patients who had treatment was shorter than the patients who had not. During the study deaths of the 14 patients were related to the CLL and deaths of 9 patients related to another reasons.DISCUSSION: Demographic features of our patients are nearly similar to other studies. Causes of shorter survival time in therapy group may be related to lack of using modern prognostic markers in our center, lack of using monoclonal antibodies on the first line therapy and poor patient adaptation to treatment.KEY WORDS: chronic lymphocytic leukemia, prognosis, survival