THE MANAGEMENT OF CHRONIC LYMPHOCYTIC-LEUKEMIA AT A SINGLE-CENTER OVER A 24-YEAR PERIOD - PROGNOSTIC FACTORS FOR SURVIVAL

Over a 24-year period, 137 patients were referred for management of ne wly diagnosed chronic lymphocytic leukemia. One hundred and nineteen p atients have been reviewed in terms of response to therapy and prognos tic factors for survival; 18 patients were excluded either because lym ph node biopsy was not compatible with the diagnosis of CLL (11 patien ts), or because the lymphocyte count at presentation was <5 x 10(9)/1 (seven patients). Patients were staged retrospectively according to bo th the Rai and Binet Classifications. Forty-eight per cent (57/119) we re deemed not to be in need of any treatment at presentation, 36 per c ent (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 patient s who responded to treatment in comparison with those who did not but this did not reach statistical significance (P=007). 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 respectiv ely. On univariate analysis, the absolute lymphocyte count at presenta tion was the most significant prognostic factor for survival, patients presenting with an absolute lymphocyte count above 50 x 10(9)/1 havin g a less favourable prognosis (P=0.002). However, on multivariate anal ysis, older age, a low hemoglobin, low platelet count, and the presenc e of lymphadenopathy and fever at presentation correlated adversely wi th 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 int o prognostic groups, however in practice, there is heterogeneity of ou tcome within stage. New approaches are urgently needed.