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Epidemiology and ethnic aspects of B cell chronic lymphocytic leukemia in Israel
L Shvidel1, M Shtarlid, A Klepfish
1Hematology Institute, Kaplan Medical Center, Hebrew University, Faculty of Medicine, Rehovot, Israel.
Insights
Chronic lymphocytic leukemia (CLL) incidence is high in Israel, particularly among Ashkenazi Jews. Despite ethnic differences in prevalence, CLL
Area of Science:
- Hematology
- Epidemiology
- Genetics
Background:
- Chronic lymphocytic leukemia (CLL) is a common leukemia in Caucasians, with higher incidence in Europe and USA compared to Asia and Africa.
- Previous studies indicate a higher prevalence of CLL in Ashkenazi Jews compared to Sephardic Jews.
Purpose of the Study:
- To investigate and compare the incidence, clinical patterns, biological parameters, prognosis, and outcomes of B cell CLL in Ashkenazi and Sephardic Jewish populations in Israel.
- To assess the impact of ethnic origin on the clinical behavior and biological parameters of CLL.
Main Methods:
- Retrospective analysis of 302 B cell CLL cases diagnosed between 1975-1996 in the Hashfela region of Israel.
- Comparison of clinical, laboratory, immunological, and genetic data between 207 patients of European/American (Ashkenazi) origin and 95 patients of Asian/Mediterranean/African (Sephardic) origin.
- Preliminary analysis of immunoglobulin heavy chain rearrangement (JH hybridization).
Main Results:
- High age-adjusted incidence of CLL in Israel (4.3 per 100,000 person-years), among the highest reported.
- Confirmed higher prevalence in Ashkenazi Jews, though the relative risk decreased over time.
- Increased CLL rates observed in both groups, notably in the Sephardic population and new immigrants from the former USSR.
- No significant differences in clinical, laboratory, or immunological parameters at diagnosis or during disease evolution between ethnic groups.
- Preliminary genetic analysis showed more aberrations in advanced CLL in Ashkenazi patients.
Conclusions:
- Ethnic origin does not appear to significantly affect the biological and clinical behavior of Chronic lymphocytic leukemia.
- The study highlights a high incidence of CLL in Israel and a changing ethnic risk ratio over time.
- Further research into genetic factors may elucidate subtle differences in disease progression.
Abstract:
Chronic lymphocytic leukemia (CLL) represents 30% of all leukemias in Caucasians. In East Europe and USA the disease incidence is high while in Asia and Africa CLL is rare. The present study deals with 302 cases of B cell CLL and related disorders; 207 patients originating from Europe and America (Ashkenazi Jews) and 95 descendants from Asia, The Mediterranean or Africa (Sephardic Jews). The patients were recruited during 1975-1996 in a single center covering the Hashfela region -- a Southern area of Israel with a current population of 430000 inhabitants. Incidence of the disease, clinical pattern, biological parameters, prognosis and outcome were investigated and compared in both ethnic groups. The results of this study show a high incidence of CLL in Israel. The mean annual age-adjusted incidence 4.3 per 100000 person-year is among the highest reported values. Our study confirms previous data on the prevalence of CLL in Ashkenazi compared to Sephardic Jews. The rise in CLL rate in the reviewed period occurred in both populations, mainly in the Sephardic group. The relative risk for Ashkenazies compared to Sephardics decreased from 6.0 in the 1975-1979 period to 2.4 in 1990-1996. A high rate of CLL was found in new immigrants from the former USSR with 26 cases de novo diagnosed and 11 prevalent cases not included in this series among approximately 60000 new immigrants in the ara over the last 8 years. No differences were found in clinical, laboratory and immunological parameters at the time of diagnosis in the two ethnic groups. The follow-up showed a similar pattern in the disease evolution. A preliminary study of immunoglobulin heavy chain rearrangement performed in 14 patients showed no significant differences in JH hybridization in the early stages of the disease, but more aberrations in advanced CLL in the Ashkenazi group. Our findings suggest that ethnic origin of the patients itself does not affect the biological and clinical behavior of this disease.
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