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Immunoglobulin Gene Sequence Analysis In Chronic Lymphocytic Leukemia: From Patient Material To Sequence Interpretation
Published on: November 26, 2018
Chronic lymphocytic leukaemia (CLL) in Central Africans
J M Mukiibi1, B Paul, C M Nyirenda
1Department of Haematology University of Malawi College of Medicine Private Bag 360 Chichiri, Blantyre 3, Malawi. jmmukiibi@yahoo.com
Insights
Chronic lymphocytic leukaemia (CLL) is common in Central Africans, presenting similarly to other populations but often diagnosed late. Improved management requires better equipped African health systems for chemotherapy and supportive care.
Area of Science:
- Hematology
- Oncology
- African Health Systems
Background:
- Chronic lymphocytic leukemia (CLL) is a hematological malignancy.
- Data on CLL clinical and hematological features in Central Africans is limited.
Purpose of the Study:
- To document the clinical and hematological features of chronic lymphocytic leukemia (CLL) in Central Africans.
- To assess the presentation and outcomes of CLL in this population.
Main Methods:
- Prospective descriptive analysis conducted in tertiary referral teaching hospitals.
- Study included 75 patients (48 from Zimbabwe, 27 from Malawi).
Main Results:
- The majority of patients (78.7%) presented at advanced Rai stages III and IV.
- Common clinical findings included splenomegaly (68%), hepatomegaly (37.3%), and anemia (34.7%).
- Treatment outcomes were impacted by late diagnosis and limited access to chemotherapy and supportive services.
Conclusions:
- CLL is not rare in Central Africans, with presentations similar to those reported globally.
- Late presentation and inadequate resources hinder optimal CLL management in the region.
- Enhancing tertiary referral centers in African health systems is crucial for improved CLL patient care.
Objective:
To document the clinical and haematological features of chronic lymphocytic leukaemia (CLL) in Central Africans.
Design:
Prospective descriptive analysis.
Setting:
Tertiary referral teaching hospitals.
Subjects:
48 Zimbabweans and 27 Malawians formed the basis of this analysis.
Results:
There were 75 patients (40 males and 35 females) studied and their ages ranged from 32 to 78 years with a mean +/- s.d. of 56.8 +/- 10.1 years. The peak age incidence of 26.7% occurred between 60 to 64 year old and 21.3% were below 50 years. The major clinical findings included: splenomegaly (68%); hepatomegaly (37.3%); anaemia (34.7%); lymphadenopathy (33.3%) and nine (12%) patients were diagnosed incidentally. The majority of patients (78.7%) had Rai stage III and IV and only seven (9.3%) patients were in stage 0. Of the 32 patients treated with chemotherapy, 25.9% and 59.3% achieved complete or partial remissions respectively. Six patients were still alive after a follow up period of a mean +/- s.d of 39.3 +/- 24.4 months; five were lost to follow up after a mean +/- s.d period of 28.6 +/- 18.8 months and 16 were dead after a mean +/- s.d. period of 25.7 +/- 19.1 months. The main causes of death in the treated group were septicaemia in six, pneumonia in four and tuberculosis in three. In the untreated group of 43 patients, two refused therapy, four died shortly after diagnosis and 37 were lost to follow up.
Conclusions And Recommendations:
Although the study has disclosed that CLL is not rare in central Africans and its presentations are similar to cases reported in the literature, the majority of patients seek medical treatment late. Optimal therapy is impossible due to lack of chemotherapy and supportive services..Therefore, it is recommended that tertiary referral centers in African health systems should be equipped for better management of CLL patients.
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