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Published on: October 19, 2014
Chronic Lymphocytic Leukemia: Prognostic Factors at Presentation in a Resource-Limited Center
Kaladada Ibitrokoemi Korubo1, Uchechukwu Prince Okite1, Sampson Ibekwe Ezeugwu1
1Department of Haematology & Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
Insights
In resource-limited settings, high white blood cell (WBC) and absolute lymphocyte counts (ALC) indicate poor prognosis for chronic lymphocytic leukemia (CLL). Chemotherapy improved survival rates for these patients.
Area of Science:
- Hematology
- Oncology
- Clinical Prognostics
Background:
- Prognostic markers for chronic lymphocytic leukemia (CLL) like TP53 and IGHV mutation are often inaccessible in low-resource settings.
- There is a need for easily obtainable prognostic factors for CLL management in low- and medium-income countries.
Purpose of the Study:
- To identify accessible prognostic factors for chronic lymphocytic leukemia (CLL) in resource-limited settings.
- To evaluate the impact of readily available clinical parameters on CLL prognosis in Nigeria.
Main Methods:
- A retrospective study analyzed 46 chronic lymphocytic leukemia (CLL) patient records from the University of Port Harcourt Teaching Hospital, Nigeria (2004-2019).
- Data included patient demographics, clinical presentation, disease stage, treatment received, and survival outcomes.
- Statistical analysis was performed using SPSS version 25.
Main Results:
- The median age of CLL patients was 55 years, with a male:female ratio of 1:1.2. Most patients presented with symptomatic disease, splenomegaly, anemia, and lymphadenopathy, predominantly at advanced Binet stage C or high-risk Rai stages III-IV.
- A 5-year overall survival of 15.7% and a median survival of 26 months were observed.
- Elevated white blood cell (WBC) count and absolute lymphocyte count (ALC) > 100 × 10^9/L were identified as significant poor prognostic markers (P = .013 and .021, respectively).
- Patients receiving chemotherapy demonstrated improved median survival (26 months) compared to those who did not (17.5 months).
Conclusions:
- White blood cell (WBC) count and absolute lymphocyte count (ALC) exceeding 100 × 10^9/L are significant indicators of poor prognosis in chronic lymphocytic leukemia (CLL).
- Chemotherapy administration was associated with better overall survival in CLL patients.
- These findings offer valuable prognostic insights for CLL management in resource-limited healthcare environments.
Purpose:
Determining chronic lymphocytic leukemia (CLL) prognosis using the International Prognostic Index markers such as TP53 and immunoglobulin heavy-chain variable region gene mutation in a resource-limited setting is difficult to achieve because of cost and equipment unavailability. The aim of this study is to determine prognostic factors easily available to hematologists in low- or medium-income countries.
Materials And Methods:
This was a retrospective study conducted at the University of Port Harcourt Teaching Hospital, Nigeria. Data were retrieved from CLL patient records from January 2004 to December 2019 (15 years). Data collected were analyzed using SPSS software version 25.
Results:
A total of 46 records were reviewed, with a median age of 55 years and a male:female ratio of 1:1.2. All patients were symptomatic at presentation, with splenomegaly (91.3%), anemia (82.6%), and lymphadenopathy (76.1%) predominating. About 89.1% of the patients presented at Binet stage C and/or high-risk Rai (Rai stages III and IV) with 10.9% presenting at Binet stage B and/or intermediate-risk Rai (Rai stage II). Only 13% of the patients had immunophenotyping done with 6.5% being done for the Matutes CLL score. The 5-year overall survival (OS) was 15.7% with a median survival of 26 months. WBC count and absolute lymphocyte count (ALC) > 100 × 109/L were significant poor prognostic markers (P = .013 and .021, respectively). Thirty-five (76.1%) received chemotherapy, and they had a better median survival than those who did not (26 v 17.5 months). The most common regimen used was cyclophosphamide, vincristine, and prednisolone for 15 (42.9%) patients.
Conclusion:
WBC count and ALC > 100 × 109/L were poor prognostic markers. Patients who received chemotherapy had a better OS.
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