The management of chronic lymphocytic leukemia at a single centre over a 24‐year period: prognostic factors for survival

Abstract

Over a 24-year period, 137 patients were referred for management of newly diagnosed chronic lymphocytic leukemia. One hundred and nineteen patients have been reviewed in terms of response to therapy and prognostic factors for survival; 18 patients were excluded either because lymph node biopsy was not compatible with the diagnosis of CLL (11 patients), or because the lymphocyte count at presentation was < 5 x 10(9)/l (seven patients). Patients were staged retrospectively according to both the Rai and Binet Classifications. Forty-eight per cent (57/119) were deemed not to be in need of any treatment at presentation, 36 per cent (43/119) have never received any specific therapy. The majority of patients received chlorambucil alone, at a dose of 10 mg daily given for 6 weeks, followed by a 2-week interval, followed by three, 2-week cycles. The overall response rate (complete+partial remission) was 38 per cent. In terms of survival, there was a trend in favour of patients who responded to treatment in comparison with those who did not but this did not reach statistical significance (P = 0.07). Correlations with stage were highly significant, the median survivals for patients with stage A, B and C disease (Binet) were 12.5, 8 and 3.5 years respectively. On univariate analysis, the absolute lymphocyte count at presentation was the most significant prognostic factor for survival, patients presenting with an absolute lymphocyte count above 50 x 10(9)/l having a less favourable prognosis (P = 0.002). However, on multivariate analysis, older age, a low hemoglobin, low platelet count, and the presence of lymphadenopathy and fever at presentation correlated adversely with survival. Overall, 40 patients died as a consequence of CLL or from disease-related causes, 34/40 dying of infection. Twenty-one patients developed second cancers. With a median follow-up of 13 years, these results confirm that the two staging systems can separate patients into prognostic groups, however in practice, there is heterogeneity of outcome within stage. New approaches are urgently needed.

Allogeneic bone marrow transplantation for low-grade lymphoma and chronic lymphocytic leukemia

“…8,9,11,[13][14][15][16] for younger patients, particularly those with refractory or recurrent disease, a more aggressive approach to treatment can be justified.…”

“…[1][2][3][4][5] Although clinical remission can be achieved with standard [6][7][8][9] and newer [10][11][12][13][14] therapies, prolonged freedom from recurrence has not been demonstrated for patients with advanced stage, making death from disease almost inevitable. 8,9,11,[13][14][15][16] for younger patients, particularly those with refractory or recurrent disease, a more aggressive approach to treatment can be justified. [17][18][19][20] High-dose therapy with allogeneic stem cell support is an attractive option for such patients, where marrow involvement is common and the occurrence of a graftversus-leukemia/lymphoma (GVL) effect [21][22][23][24][25][26] may contribute to the achievement of long-term disease control.…”

Infectious Complications in Chronic Lymphocytic Leukemia

“…In a large 24-years observational study of M.D. Anderson Cancer Center 30% of patients died because of infection;24 however, this retrospective study was performed to verify different drug combinations and not to investigate the origin of infections and the cause of death; reported data often don’t permit correct evaluation of infectious episodes and presence of correlation with hypogammaglobulinemia, neutropenia, previous treatments and stage of CLL; moreover, they reported data of a selected population with advanced or refractory disease, which is typical of third level centres, to whom more complicated cases are admitted. Despite these limitations, it is evident that the incidence of infections in CLL patients is higher than in the general population, and it develops parallel to the progression of the haematologic disease.…”

B‐chronic lymphocytic leukemia: practical aspects

“…Pure splenic forms of B-CLL have been described and tend to have a more favourable course. 22 Extranodal localizations in the tonsils 21,23 and skin 24,25 may be seen. Other extranodal sites, as the gastrointestinal tract, lungs, pleura, CNS, kidneys, bone etc., are involved very rarely (<1%) and such involvement should be distinguished from infection, adverse effects of treatment, transformation to a more aggressive lymphoid malignancy or secondary neoplasia.…”

“…Constitutional symptoms are infrequent, being present in approximately 15% of the patients at diagnosis. 15,20,21 Night sweats, weight loss and fatigue are more frequently encountered than disease-related fever.…”