COMPARISON OF YOUNGER VERSUS OLDER B-CELL CHRONIC LYMPHOCYTIC-LEUKEMIA PATIENTS FOR CLINICAL PRESENTATION AND PROGNOSIS - A RETROSPECTIVE STUDY OF 53 CASES

Fifty-three patients affected with B-cell chronic lymphocytic leukemia (CLL) younger than 50 years and observed in two hematological institu tions have been retrospectively evaluated in order to verify whether t his disease has different clinico-hematological features at presentati on and different prognosis as compared to older cases. In our experien ce young cases with B-CLL diagnosis, confirmed by immunophenotype in 9 0.5% of patients, accounted for 7.1% of the whole CLL population. Sex distribution, mean peripheral lymphocyte count, platelet count, distri bution among Rai's and Binet's stages, total tumor mass (TTM) score, h istological pattern of bone marrow infiltration and lymphocyte doublin g time (LDT) were similar to a series of 201 CLL cases older than 50 y ears. Only hemoglobin mean level was significantly higher in younger p atients (13.1 +/- 2.1 vs 12.2 +/- 2.6 g/dl; p < 0.01). The overall med ian survival was 7.1 years. Rai and Binet staging classifications and TTM score system retained their prognostic value in this CLL populatio n. In addition, cases fulfilling criteria of ''smoldering'' CLL, had a very long survival (75% survival probability at 16 years). Life-expec tancy of younger patients was significantly longer than that of older ones (median survival, 7.1 versus 4.1 years; p < 0.05). However, when the background mortality due to non-CLL related deaths (i.e., cardiova scular complications, epithelial cancers) was removed, survival advant age of young cases disappeared. In conclusion this study confirms that prognosis of young CLL patients can be easily assessed using the curr ent well-defined criteria. Since age is not by itself a criterion for intensifying treatment, further efforts to identify those young CLL pa tients who qualify for more aggressive therapy should be made.