Chronic Lymphocytic Leukemia and Prognostic Factors


Background: The clinical course of individual chronic lymphocytic leukemia (CLL) is highly variable andclinical staging systems do not help us to predict if and at what rate there will be disease progression in anindividual patient diagnosed with early stage disease. Recently, several important observations related to otherprognostic factors including lymphocyte doubling time (LDT), ß2-microglobulin (ß2-MG), and percent of smudgecell in peripheral blood smears, cytogenetic and molecular analysis have been made. The aim of this study wasto evaluate a range of prognostic factors in our CLL patients. Design and methods: Seventy patients with CLLwere enrolled. Prognostic factors of disease including Binet staging, LDT, ß2-MG, ESR, LDH, percent of smudgecell in peripheral blood smear, absolute lymphocyte count, and conventional cytogenetic (CC) analysis wereevaluated at diagnosis, and the patients were followed up to determine their outcome. We compared factors witheach other and with Binet staging and prognosis.
Results: Enrolled patients aged 37–85 years at diagnosis orduring follow up. There was no relationship between serum LDH level (P=0.3), ESR (P=0.11), percent of smudgecells in peripheral blood smear (P=0.94), and absolute lymphocyte count (P=0.18) with the stage of disease andprognosis, but the β2 macroglobulin level (p<0.0001), LDT (p<0.001) had direct and significant relation withstaging and outcome. In 19% of patients cytogenetic alteration were seen.
Conclusion: The detection of cytogeneticalteration only using the CC method is not sufficient and we need to use FISH, but because FISH study is anexpensive method not available in all areas, instead we believe that β2 MG can be applied in its place as a goodprognostic factor for CLL at diagnosis and during follow up. We suggest to add it to Binet staging for prognosticsubgrouping of CLL.