Avaliação clínico-epidemiológica e molecular de pacientes com leucemia linfocítica crônica atendidos no Hospital Universitário Walter Cantídio

Abstract

Chronic lymphocytic leukemia (CLL) is a chronic lymphoproliferative disease characterized by the accumulation of clonal B lymphocytes with coexpression of CD19 and CD5, in addition to CD 23, weak CD 20 and negativity for FMC7. According to the World Health Organization (WHO), more than 5,000 / mm³ B lymphocytes with persistent suggestive phenotype are required for at least 3 months. It is the most prevalent leukemia in adults in the West. It has an indolent behavior with lower survival than the general population, but still prolonged. It is predominantly male and affects older individuals, especially over 65 years. Pathophysiology has two main points: loss of apoptosis capacity and proliferative stimulation. This was a cross-sectional study of 147 patients diagnosed with chronic lymphocytic leukemia followed during the period of 02/03/2017 and 30/04/2019 at the outpatient clinic of chronic lymphoproliferative diseases at Walter Cantídio University Hopsital. Sociodemographic and molecular variables and their relationship with time to first treatment and overall survival were analyzed. For statistical analysis, GraphPad Prisma 7 software was used. The median age of diagnosis was 70 years, with a slight predominance in males, with a ratio of 1.13: 1. The origin of 66% of the patients came from the metropolitan region of Fortaleza. Diagnosis was made by peripheral blood flow cytometry in more than 90% of patients. Direct antiglobulin test was positive in 11%. 58% were staged as BINET A, 13% as B and 29% as C. For modified RAI staging, 34% were low risk, 36% intermediate risk and 30% high risk. IGHV status was mutated in 49% and not mutated in 34% of patients. TP53 mutation was present in 5 patients. The median time to first treatment (TPPT) was 3.2 years. Factors related to higher TPPT were: age <60 years (p = 0.491), female gender (p = 0.0052), hemoglobin ≥10g / dL and lymphometry <50,000 / mm³ at diagnosis (p = 0.0001), platelet analysis at diagnosis ≥100,000 / mm³ (p = 0.0054), low risk modified BINET A and RAI staging (p = 0.0001) and mutated IGHV (p = 0.0293). The median overall survival (SG) of CLL patients was 12 years. Factors related to longer survival were: female gender (p = 0.0152), hemoglobin at diagnosis ≥10g / dL (p = 0.0005), lymphometry <50,000 / mm³ at diagnosis (p = 0.0174), BINET staging A (p = 0.0105), modified low-risk RAI (p = 0.0023) and no previous treatment (p = 0.0023). Unlike in other countries, a slightly higher prevalence was observed in males, but when considering individuals over 65 years, it is more prevalent in females. Older patients had no worse prognostic factors when stratified by socio-demographic and molecular variables. Mutated IGHV status was related to higher TPPT, but not to SG. The presence of TP53 mutation was not related to lower TPPT or SG. Knowing the clinical and epidemiological data of the patients with CLL and the risk factors for shorter time to treatment and shorter overall survival contributes to better management of this condition and assists in health service programming.