Chronic Lymphocytic Leukemia: Prognostic Factors at Presentation in a Resource-Limited Center

Abstract

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.

Trends in Disease Burden of Chronic Lymphocytic Leukemia at the Global, Regional, and National Levels From 1990 to 2019, and Projections Until 2030: A Population-Based Epidemiologic Study

“…The low male-to-female ratios are predominant in Africa, South Asia, Greenland, Mongolia, and some countries in Southeast Asia ( Supplementary Figure S2 ). Some studies achieved similar results ( 44 , 53 ), while others did not ( 40 – 42 ). Considering the possible underestimation of incidence rates in lower SDI countries and the male-to-female ratio of CLL in African American patients (male-to-female ratio ≥ 1), we infer that the incidence rates of men were underestimated more badly than those of women.…”

“…In a resource-limited hospital in Nigeria, the major first-line chemotherapy used was cyclophosphamide, vincristine, and prednisolone (CVP) for 42.9% of patients, followed by chlorambucil and prednisolone (CP) for 31.4%. Few patients are accessible to newer drugs, like rituximab with cyclophosphamide, hydroxodaunorubicin, oncovin, and prednisolone (R-CHOP), or fludarabine, cyclophosphamide, and prednisolone (FCP) ( 53 ). This situation may partly explain the increasingly serious disease burden of death and DALY in low SDI countries.…”

Investigação da infecção por Epstein Barr vírus (EBV) e associação com o perfil epidemiológico, clínico e citogenético de pacientes portadores de leucemia linfocítica crônica (LLC) / Investigation of Epstein Barr virus (EBV) infection and association with the epidemiological, clinical and cytogenetic profile of patients with chronic lymphocytic leukemia (LLC)

“…Linfocitose acima de 50.000 foi encontrada em 30,43% dos pacientes. Estudo realizado na Nigéria demonstrou que pacientes com LLC que possuíam hiperleucocitose tiveram uma taxa de sobrevida mediana pior e estatisticamente significativa comparada Brazilian Journal of Development, Curitiba, v.8, n.5, p. 34222-34244, may., 2022 aqueles com contagens de leucócitos mais baixas, sugerindo que uma alta carga tumoral é uma característica de mau prognóstico (37) .…”

TP53 Gene 72 Arg/Pro (rs1042522) single nucleotide polymorphism increases the risk and the severity of chronic lymphocytic leukemia

“…Non-mutated heavy-chain variable-region genes (IGHVs) and high level of CD38 (≥ 30%) are associated with more aggressive disease compared to those carrying mutated IGHVs and CD38 (< 30%) ( 21 , 22 ). Other prognostic factors such as the presence of certain comorbidities, blood B cell count, hemoglobin level, and platelet count are also associated with CLL severity ( 23 ).…”