Clinical Features And Prognosis Analysis Of 54 Chronic Lymphocytic Leukemia Patients

Objective:Explore the possible prognostic factors of CLL through the analysis of 54 CLL patients'clinical symptoms,laboratory features and follow-up data.Methods:Retrospectively analyze 54 patients admitted to Department of Hematology,the second hospital of Shanxi Medical University from January 2002 to December 2017 with their clinical features,laboratory examinations,treatment process and outcome.We use the chi square test and Fisher exact probability test to detect statistical differences.Kaplan-Meier method was used to calculate the survival rate and draw the survival curve.Log-rank test was used to compare the survival rates between different groups.COX proportional hazards model was used for multivariate analysis of prognostic factors in CLL.Results:1.Clinical features:The male to female ratio was 2:1 among 54 cases of patients,the median age was 64-years-old.There were 8 cases belong to Binet A,25 cases belong to Binet B and 21 cases belong to Binet C.There were 34 cases with enlarged lymph nodes,19 cases with splenomegaly,15 cases with unknown increased of white blood cells,13cases of anemia,7 cases of fever,2 cases of weight loss,1 cases of epistaxis and 2 cases of skin rash.2.Laboratory examination:Blood test:WBC count was among 7.8 to281×10~9/L,and there were 96.3 percent of patients'WBC was high above 10×10~9/L,lymphocyte count was among 5.71 to 249×10~9/L,AMC was among 0.02 to 4.66×10~9/L.Serum biochemical:There were 11 cases showed elevated LDH levels,and 41 cases showed elevated?2-microglobulin.Serum immunoglobulin:We detected 24 cases of patients,there were 6 cases showed IgG were lower than normal,IgM and IgA decreased respectively were 5 cases and 7 cases.Immunotype were detected in 46 cases,the positive rate of CD19 was 94.13%,CD5 positive rate was 85.39%,the positive rate of CD20 was 76.12%,the positive rate of cyCD79a was 75.91%,the positive rate of CD11c was 38.57%,CD7 positive rate was 39.25%.The positive rates of ZAP70 and CD38detection were 21.7%and 28.3%.Chromosome detection:Among 23 cases,8 cases were detected abnormalities,including 3 cases of P53 gene deletion,2 cases of trisomy 12chromosome,1 complicated karyotype,5 cases of 13q14 deletion and 4 cases of 11q22deletion.9 cases of detection of IgVH gene mutation was found in 3 cases.T cell subsets:Th cells,Ts cells,T cells,NK cell percentage was significantly lower of these 43 patients than that in normal,the percentage of CD19+cells was significantly increased by 84.8(33.3~98.2)%.3.treatment and prognosis:Immunochemotherapy were used as the main treatment,there were 20 cases used FC and similar programs,18 cases used chlorambucil or bendamustine treatment,2 cases used CHOP and similar regimen.Relapsed or refractory CLL patients were 8 cases and were used fludarabine chemotherapy,3 cases of them achieved CR.We used disease progression to get the ROC curve of AMC,the cutoff point of AMC is 0.67×10~9/L,the optimal curve of sensitivity was 0.710,specificity was 0.783,the area under the curve(AUC)was 0.771(95%CI,0.644-0.899).We divided the patients into high AMC group and low AMC group according to the cutoff point.There was no significant differences between high AMC group and low AMC group in OS(P=0.17),but PFS results suggested high AMC group may progress quicker than low AMC group(P<0.05).COX regression analysis suggested that disease stage was an independent factor affecting OS,while the AMC at the diagnosis and the stage of disease were independent risk factors of progression free survival.Conclusion:1.The data from our hospital suggested that the onset age of CLL was more than 60years and there was a male predominance.The lymph nodes enlargement were always the first symptom and the patients were frequently in Binet B or C when first diagnosis.2.CLL is often associated with autoimmune cytopenias.CLL can appear CD38 and ZAP70 expression,besides,IgVH gene mutation and 17p13 gene deletion could be observed too.CD19+cell percentage of T cell subsets were significantly increased,while Th cells,Ts cells,total T cells and NK cell percentage was significantly decreased.3.AMC>0.67×10~9/L and clinical stage C at first diagnosis were independent prognostic factors for PFS,but OS was only affectd by the clinical stage.