Chronic lymphocytic leukemia – Internationa Prognostic Index for Macedonian Patients with Chronic Lymphocytic Leukemia

Abstract

Introduction: Several prognostic factors have been identified to predict the outcome of patients with Chronic lymphocytic leukemia(CLL), but only a few studies investigated more markers together. To predict the time to first treatment (TFT) we integrated the data of traditional staging system, cytogenetic aberrations, and mutational status of immunoglobulin heavy chain variable region (IGHV) in Chronic lymphocytic leukemia– Internationa Prognostic Index(CLL-IPI). Aim of the study: To validate the prognostic value of chronic lymphocytic leukemia-international prognostic index (CLL-IPI) for Macedonian CLL patients. Material and Methods: The study is set up retrospectively and includes 75 patients with CLL diagnosed and treated at the University Clinic of Hematology for a period of time from January 2011 to January 2018. The median follow-up was 36 months (1-72 months).We recognized the prognostic markers of TFT,in line of definition that prognostic markers we incorporated the data of Rai staging system, most adverse cytogenetic marker and mutational status of immunoglobulin heavy chain. Results: The statistical data of the 75 patients shows that58.7% were males and 41.3% were females, with a median age of 64.3 (42-85) years old. The median TFS for low CLL-IPI (n=20), intermediate CLL-IPI (n=27), high risk CLL-IPI (n=15) and very high risk group (n=7) according to the CLL-IPI scoring system was 7.9, 7.6, 7.0 and 5.8 months, respectively. The median OS for low risk group was 58.5 for intermediate, high, and very high risk group was 37.8, 34.6 and 30 months, respectively. The estimated 5-year OS rate was 98.7%, 92%, 40% and 33%, respectively for low risk group intermediate, high, and very high risk group. Multivariate analysis indicated that del 17p (P< 0.00874) was independent prognostic factors of TFS. Conclusions: CLL-IPI is the powerful tool for risk stratification in Macedonian CLL patients and this system also provided treatment recommendations for the different patient risk subgroup.Though, it is unknown how newly developed CLL therapies and newly identified prognostic and predictive markers would be merged into this revised staging system.