| Objective: To study the clinical and laboratorial characteristics of patients with chronic lymphatic leukemia(CLL),as well as their relationship with outcomes of patients.Methods: Collected the clinical date of 63 cases of initially treated CLL patients in our Hospital in recent 10 years using different treatment schemes, we observed the clinical and laboratorial efficacy,adverse reactions of different therapeutic schemes.Statistical differences were analyzed by Chi square test and Fisher exact probability method.The survival rate was calculated by Kaplan-Meier method. Log-rank test was introduced to compare the survival rate.Multivariate factors for the survival rate were analyzed by Cox proportional hazards regression model.Result: 1.Clinnical features:The male/female ratio in the 64 cases was 2.15:1 and the median age of presentation was 62 years. In all of the 63 cases,there were 19 cases at Binet stage A,15 cases at Binet stage B and 29 cases at Binet stage C. In the first visiting patients there were 38 cases with enlarged lymph nodes,29 cases with anaemia,6 cases with fever, 7 cases with hepatomegaly,35 cases with splenomegaly,3 cases with hemorrhage, and 3 cases with pharyngalgia.2.Laboratory examination:Blood count: In all patients,there were 57 cases met the condition that WBC>10×109/L、Lymphocyte proportion >50% and lymphocyte count>5 × 109/L.Serumal biochemical indicator:The levels of LDH:94~2268U/L,21 cases were supernormal. Serum immune globulin:We determined28 case,5 cases with hypo-Ig G,11 cases with hypo-Ig A,8 cases with hypo-Ig M, and7 cases was normal,moreover 7 cases with high immunoglobulin.Immunophenotyping: We determined 49 cases,the positive rate of CD5, CD19 and CD20 was 87.50%,100% and 93.75%.Moreover we detected CD38 and ZAP70 expression in 30 cases, showed 11 cases of CD38+, 8 cases of ZAP70+.Detectionof chromosome: 3 cases of P53 gene deletion while 16 cases with normal karyotype. Detection of Ig VH gene mutation:6 cases with Ig VH gene mutation positive. 3.Treatment and curative effect: The main treatment we used was chemotherapy. 20 cases oraled Chlorambuci, 23 cases treated with CHOP regimen chemotherapy and the chemotherapy like CHOP,11 cases treated with FC(R)regimen chemotherapy. The Comparison of CR rate and OR rate of two kinds of treatment showed no statistical significance(P>0.05). 11 cases of refractoriness or relapse received the chemotherapy which including Fludarabin and then 4 cases achieved CR.Significant difference in the rate of OR was noted in the CD38 positive group and in negative group(P<0.05),the same as comparing the ZAP70+group with ZAP70- group(P<0.05).The difference of OR rate between Ig VH gene mutation positive and the normal group were not statistically significant(P>0.05).Significant difference in the survival rate was noted in the high LDH group and in normal group(P<0.05).There was a significant difference by comparing the survival rate between different Binet stage(P<0.01).Moreover there were statistically significant differences between Binet stage A and C as well as between Binet stage B and C(P<0.05).Cox proportional hazards regression model displayed the factors which impacted the survival were clinical stage and the level of LDH.Conclusion: 1.CLL is likely to occur in the people beyond 60 years old,especially in male.The most common clinical manifestation was lymph nodes enlarged. When the patients went to hospital for the first time,they usually in the Binet stage B or Binet stage C. 2.CLL could occurring with Ig VH gene mutation, P53 gene deletion,CD38 and ZAP70 expression.Ig G, Ig A and Ig M were decreased while some patients had high immunoglobulin.3. The factors which impacted the survival consisted of clinical stage and the level of LDH.Many Immunological markers such as ZAP70,CD38 were associated with prediction of outcomes for patients. |
PDF Full Text Request