Faculty of Medicine
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Item type:Publication, CIRS-G score as a rapid way to determine the overall multimorbidity burden and to select optimal and individualized therapy in newly diagnosed eldery CLL patients(Македонско лекарско друштво = Macedonian Medical Association, 2020); ; ; ; Slobodanka Trpkovska TerzievaIntroduction. Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the elderly population. Many of these patients have multiple comorbidities, which might influence the choice of an adequate upfront chemoimmunotherapy option. The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score seems to be a reliable tool for assessment of the burden of comorbidity in elderly cancer patients. Objectives. The primary objective of our study was to assess the distribution of CIRS score status in CLL patients in real clinical practice. The secondary objective was to analyze which treatment option was used, and the effects it produced in each patients’ group, classified according to the CIRS score. Methods. In our prospective, single-center study, we focused on CLL patients that were referred to the University Clinic for Hematology in Skopje between 2017 and 2019. Comorbidity was assessed by the CIRS-G score in all patients included in our study (n=56) prior to the process of deciding on the most adequate treatment option. Results. The median age was 69 (±9.4) years. Comorbidities were identified in 80.4% of the study population, with an average CIRS score of 3.9. The three most common comorbidities were related to involvement of the vascular system (41.1%), endocrine-metabolic disorders (32.1%), and respiratory system disorders (17.9%). Only 16.1% of the patients had only 1 affected organ or system, other than hematological issues, while 64% of the patients had ≥2 affected systems. In 33.9% of the study patient cohort, the watch and wait initial approach was the standard of care. We considered 66.1% of patients to be requiring treatment, as follows: chemotherapy (chlorambucil, fludarabine+cyclophosphamide, bendamustine) only (30.4%), rituximab-based therapy (33.9%), and 1.8% of patients, due to the high comorbidity burden, were eligible only for supportive care. There was a stable trend of correlation between the CIRS score assessment and the treatment option prescribed (rs=0.7188, p<0.000001). Conclusions. The comorbidity status is a major consideration when treating elderly patients with CLL. Our study shows that comorbidity is quite a common feature in CLL patients and that it is increasing with age. CIRS is helpful in identifying the best treatment combination for the patients, that will enhance achieving long-term control of CLL, maintaining an optimal quality of life level. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Chronic lymphocytic leukemia following successfull treatment of Hodgkin’s lymphoma: report of two patients(Македонско лекарско друштво = Macedonian Medical Association, 2017); ; ; ; Arif LatifiOver the past few decades, introducing effective therapy, improved staging procedures, and significant improvement of supportive measures, significantly improved the prospects for patients with Hodgkin's lymphoma, leading to a 75-90% cure rate. Hodgkin's lymphoma survivors are at high risk of developing a large variety of second malignant neoplasms. It is crucial to maintain awareness regarding this issue. The subsequent development of Chronic Lymphocytic Leukemia (CLL) in patients after successful treatment of Hodgkin's lymphoma (HL) is an extremely rare possibility. The relationship between these two lymphoproliferative disorders is unclear. Herein we describe two cases of CLL, developed in previously treated patients with HL, with characterization of two distinct lymphoproliferative disease in these two patients. We also systematically reviewed the existing literature on this very rare occurrence of treatment-induced second hematological malignancies. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Current status in management of patients with chronic lymphocytic leukemia (CLL) in Republic of Macedonia(Macedonian Medical Association/ Walter de Gruyter GmbH, 2016-01); ; ; ; Lidija CevreskaChronic lymphocytic leukemia (CLL) is the most commonly diagnosed type of leukemia in Western Europe and North America, and represents about 30% of all leukemias in adults. CLL is a disease of elderly, who often have multiple comorbidities. These factors affect further treatment decisions, despite the great progress in the therapy of CLL in the last two decades. The aim of this study was to evaluate the current status in the management of patients with CLL in the Republic of Macedonia and to compare it with CLL patients in other western countries. We analyzed 102 patients with CLL referred to our Institution for control and/or treatment in the period from January 2015 to October 2015. Median age of our group of patients at the time of diagnosis was 62.7 years with almost 40% of patients older than 64 years. Male to female ratio was 1.3:1 and 54% of patients were diagnosed in stage "0" according to Rai staging system. Watch and wait was the most common treatment approach (58.8%) at the time of diagnosis, but at the moment of analysis only 33% of patients were still without treatment. The most common treatment in this group of CLL patients was FCR protocol with 39.5% of patients treated with an average of 5 cycles of this immunochemotherapeutic regimen. The average time of progression free survival (PFS) in all treated patients was 32.8 months with range between 2-72 months. In summary, clinical characteristics of CLL patient in our clinical settings and the most common therapeutic approach at our Institution do not differ significantly from the characteristics of the average CLL patient in other studies.