Untreated Chronic Lymphocytic Leukemia in Lebanese Patients: An Observational Study Using Standard Karyotyping and FISH

Abstract

Background • The chronic lymphocytic leukemia (CLL) pathogenesis shows a molecularly variable disease with particular cytogenetic characteristics that constitute nowadays the major prognostic factors. • The epidemiology of CLL in the Middle Eastern population has not been fully studied. • The modeling of the CLL epidemiology at the population level is required to personalize the treatment plan at the individual level. Patients & methods • All the newly diagnosed CLL patients who did not require treatment were eligible. • Patients were investigated for demographic characteristics and CLL testing by cytogenetics and FISH. Results • Chromosomal aberrations on classical karyotype were found 53.6% among which 26.7% present complex rearrangements. • The most frequent abnormality in all patients was del(13q14) [46.4%] occurring as a sole abnormality in ten cases. • FISH studies identified ch14q32 rearrangement (25.0%), followed by trisomy 12 (14.3%), del(17p13) and del(11q22) in 7.1% each. Discussion • Similar to large studies from both Western and Eastern countries, del(13q14) was the most common abnormality in CLL patients. • It is rational to encounter low incidence of poor prognosis FISH abnormalities in our watch and wait CLL patients. Conclusion • The higher prevalence of del(13q14) as a sole abnormality could be the primary event in inducing CLL. • The del(17p13) and del(11q22) follow and could be drivers for CLL progression. Aim: We aimed to understand the biology of chronic lymphocytic leukemia (CLL) patients in Lebanon. Materials & methods: We applied conventional cytogenetic and FISH studies on Lebanese patients diagnosed with CLL and undergoing a watch and wait approach. Results: Our study disclosed 53.6% of patients with aberrant karyotypes among which 26.7% were complex karyotypes. Genetic aberrations included del(13q14) 46.4%, 14q32 translocation in 25%, trisomy 12 in 14.3%, del(17p13) and del(11q22) in 7.1% each. The deletion of 6q21/6q23 was not found in any of our patients. Conclusion: The higher prevalence of del(13q14) as a sole abnormality could be the primary event in inducing CLL. The del(17p13) and del(11q22) followed as potential drivers for progression in CLL patients with a watch and wait approach.

Prognostic impact of chronic lymphocytic leukemia comorbidity index in a young population: a real-world evidence study of a national gulf region cohort

“…In contrast to Western countries, the Middle Eastern population tends to be younger, potentially with a different profile of comorbidities [ 10 , 11 ]. Comorbidities have been shown to impact survival outcomes in patients with CLL [ 4 ].…”

“…A national Danish CLL registry study then confirmed the ability of CLL-CI to predict time to first treatment (TTFT), EFS, and overall survival (OS), with the latter two outcomes measured from both diagnosis and first treatment [ 9 ]. The Middle Eastern CLL population, however, is much younger (median age at CLL diagnosis of 59 years) than in the West (median age of 70 years) and has a different comorbidity profile [ 10 , 11 ].…”

Evaluation of the CLL-IPI and IPS-E Prognostic Indices in a Young Middle Eastern Population with Chronic Lymphocytic Leukemia: A Retrospective Analysis at the Kuwait Cancer Control Center

“…Compared to Western cohorts, the Middle Eastern population tends to be younger and has different genetic profile [ 19 , 20 ]. This raises potential implications for the validity of widely used prognostic scores originally developed in the West.…”

“…The Middle East has a notably younger CLL population, with a median age at diagnosis of 59 years, compared to 70 in Western populations [18][19][20]. Furthermore, there are some genetic differences between Middle Eastern and Western CLL patients [19].…”

Application of an Artificial Neural Network in the Diagnosis of Chronic Lymphocytic Leukemia

“…The etiology of CLL is still elusive, however, it is most likely that genetics and environmental factors have an important effect on its occurrence [4][5]. In the karyotype experiments, del13q14, trisomy 12, del11q22-q23, and del17p13 were associated with CLL [6]. Several other molecular pathologies were found in CLL, such as the overexpression of the unmutated immunoglobulin heavy chain variable region (IGHV) genes, zeta-chainassociated protein kinase 70 (ZAP-70), CD38 proteins, and mutations in the NOTCH1, splicing factor 3b subunit 1 (SF3B1), and baculoviral IAP repeat-containing 3 (BIRC3) genes.…”