Outcomes of first line chemotherapy in patientswith chronic lymphocytic leukemia

Abstract

Objective:Chronic lymphocytic leukemia (CLL) is a heterogeneous disease in terms of survival with and without treatment. Many chemo and immunotherapeutic agents are available to treat this indolent disease. Aim of this study was to determine the outcomes of patients with chronic lymphocytic leukemia treated with different available chemotherapeutic regimens.Methods:All patients with diagnosis of CLL from 2008 to 2013 were included. Data were collected from hospital information system. Objective response rate (ORR) in terms of complete or partial response (CR, PR), stable or progressive disease (SD, PD), overall survival (OS), and progression free survival (PFS) were calculated.Results:Fifty seven patients were included; 42 (74%) male and 15 (26%) were female. Patients with Binet stage A 10 (18%); B 20 (35%) and C were 27(47%). Median age was 50.9 years. Forty six (80%) were treated and 11(20%) remained on watch and wait. Treatment indications were B symptoms 14 (30%), symptomatic nodal disease 18(39%), thrombocytopenia 4(9%), anemia 7(15%) and doubling of lymphocyte count 3 (7%). Chemotherapy regimens used were FC in 38 (83%), FCR 5(11%), chlorambucil 2(4%) and CVP in 1(2%) patient. Twenty two (56%) patients had CR, 13(33%) PR, 3(7.6 %) SD, and 1(2.5%) had PD. ORR was 89%. Median PFS was 23.1 months and median 3 years OS was 55%.Conclusion:Majority of patients was in a relatively younger age group and presented with advanced stage disease requiring treatment. Small number of patients received rituximab due to cost. PFS and OS are comparable with published literature.

Association of serum protein electrophoresis with clinicopathological characteristics and its prognostic relevance in chronic lymphocytic leukaemia patients

“…This age distribution in CLL was consistent with other Pakistani and Indian studies. 17,18 In comparison, median age at diagnosis was slightly higher in Chinese CLL patients (64 years) and Caucasian CLL patients (70-72 years), with <10% patients being diagnosed at age <55 years. [19][20][21] This may reflect referral bias, but may also be suggestive of a genetic predisposition for Indo-Pak CLL patients to present at a younger age, especially considering higher rates of consanguinity in this ethnic group, and can be of significance as this earlier-age CLL may represent a severe disease with worse prognosis and inferior survival outcomes.…”

“…22 Regarding gender distribution, male predominance seemed to be a universal characteristic of almost all CLL cohorts. [17][18][19][20][21][22][23][24] CLL has a highly variable natural course with OS ranging from a few years to several decades. The Binet and Rai staging systems still provide a simplified way based on a few simple clinical and laboratory variables, especially in resource-limited healthcare systems, to predict CLL disease progression at diagnosis despite being almost half-a-century old.…”

Clinical Research in Chronic Lymphocytic Leukemia in Pakistan; A Systematic Review

“…A total of 16 studies met the inclusion criteria (n = 1264 patients) [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. The summary of the included studies is provided in Table 1 and Table 2 .…”

“…The study group had a generally favorable outcome as 22 patients (56%) achieved complete response, 13 (33%) had a partial response, 3 (7.6%) had stable disease, and 1 (2.5%) patient had disease progression. More relapses were seen in the FC group as compared to the FCR group and the authors concluded that the addition of rituximab to the regimen results in improved outcomes [ 21 ].…”

“…Clinical studies from Pakistan related to therapeutics in CLL are scarce. Apart from the earlier discussed study [ 20 ], our review identified only one additional observational study done with the goal of evaluating the treatment outcomes of CLL patients in Pakistan [ 20 , 21 ]. Neither of these studies had any patients on the novel targeted agents.…”