The Clinical Features And Prognostic Factors Of 110 Newly Diagnosed Chronic Lymphocytic Leukemia

Objective:To retrospectively analyze the clinical features and major laboratory indicators of chronic lymphocytic leukemia,explore the influencing factors of the prognosis of CLL patients,so as to raise awareness of CLL.Methods:The clinical features,major laboratory parameters,and prognosis of 110pathologically confirmed patients with newly diagnosed chronic lymphocytic leukemia collected from January 2010 to May 2017 were collected at the Union Hospital of Fujian Medical University.Data analysis using SPSS 20.0 version,using the Log-rank test for univariate analysis,multivariate analysis using the COX proportional hazards model,single factor analysis of the factors involved in the multi-factor analysis,all tests statistical significance of 0.05 as the test standard.Results:Of the 110 newly diagnosed CLL patients,68(61.8%)were males and 42(38.2%)were females.The male to female ratio was 1.61:1.The age of onset was 42-84years,and the median age was 64.5 years.There were 29 cases(26.4%)in Binet stage A,46 cases(41.8%)in stage B,35 cases(31.8%)in stage C,45 cases(40.9%)in Rai stage,Rai stage0-I,and 28 cases(25.5%)in Rai stage II,There were 14 cases(12.7%)in Rai stage III and 23 cases(20.9%)in Rai stage IV.110 cases of lymphadenopathy(100%),lymph nodes(cervical,subphrenic,inguinal lymph nodes,liver,spleen)?3cases(74.5%),lymph nodes<3 27 cases(24.5%),18 cases of hepatomegaly(16.4%),splenomegaly in 53 cases(48.2%).Treatment reasons:Elevated white blood cells were found in 38 cases(34.5%),lymphadenopathy in 27 cases(24.5%),splenomegaly in 11cases(10%),anemia in 13 cases(11.8%),fever in 8 cases(7.3%),fatigue Eight patients(7.3%)had pharyngeal pain in 2 patients(1.8%),dizziness in 1 patient(0.9%),bleeding in 1 patient(0.9%),and abdominal distention in 1 patient(0.9%).Blood tests were performed in all patients:the median white blood cell count was 25.88(3.22-182)�109/L,the median lymphocyte was 73.8%(27.94-88.80)%,and the median absolute lymphocyte count was 18.23(1.81-155.7).�10~9/L,in which lymphocyte absolute value>50�10~9/L accounted for 17 cases(15.5%).The median hemoglobin was 123.50(54-219)g/L,of which<110 g accounted for 19(17.3%).Platelets 188(11-390)�10~9/L,of which<100�10~9/L accounted for 14 cases(12.7%).Serum biochemical indicators:Serum lactate dehydrogenase was detected in all patients,with a median LDH of 192.5(101-625)U/L,an increase of 25 cases(22.7%),and normal 85cases(77.3%).Seventy patients were tested for blood?-2MG,with a median of 2.30(0.75-10)mg/L,an increase of 27(24.5%),and normal 43(75.5%).54 people tested urinary?-2MG,increased in 37 cases(68.5%),and normal in 17 cases(31.5%).Serum immunoglobulin was detected in 19 people:IgG decreased in 8 cases(42.1%),normal in 4 cases(21.1%),and increased in 7 cases(36.8%).IgM decreased in 14 cases(73.7%),normal in 3 cases(15.8%),and increased in 2 cases(10.5%).IgA decreased in16 cases(84.2%),normal in 3 cases(15.8%),and increased in 0 cases(0%).The expression of RB1,p53,ATM,DS1325 and CSP12 was detected by FISH:the mutation rate of RB1 gene was 25/81(30.9%),the mutation rate of P53 gene was 15/82(18.3%),and the mutation rate of ATM gene was 9/79(11.4).%),the mutation rate of D13S25gene was 43/79(54.4%),and the amplification rate of CSP12 gene was 17/77(15.5%).IgVH,Ig DH,Ig K,TCR gene rearrangement mutations:IgVH gene mutation rate of17/19 cases(89.5%),IgDH gene mutation rate of 12/14 cases(85.7%),Igk gene mutation rate of 19/21 cases(90.5%),TCR gene mutation rate 7/16 cases(43.8%).A total of 40 people detected ZAP70,CD38 expression:ZAP70 negative in 28 cases(70%),ZAP70 positive in 12 cases(30%),CD38 negative in 25 cases(62.5%),CD38positive in 15 cases(37.5%).Prognostic analysis:The median follow-up time for all CLL patients was 32(1-92)months,and the 1-year overall survival(OS)was 95.4%.The 2-year overall survival(OS)was 90.0%.The 3-year overall survival rate(OS)was89.7%,4-year overall survival(OS)was 82.6%,5-year overall survival(OS)was 75.8%,univariate analysis showed that the number of affected lymph node regions was?3,late Rai stage,late Binet stage,P53 loss,spleen Large,platelet<100�109/L,increased lactate dehydrogenase,CD38 positive,and ZAP70 positive were poor prognostic factors.Multivariate analysis showed that late stage of Rai was an independent prognostic factor.Conclusion:1.CLL is common in elderly males(>60 years old).Most of the patients are diagnosed with elevated white blood cells or lymphadenopathy on physical examination.2.CLL may have rearrangement mutations of IgVH,IgDH,IgK,TCR,deletion or amplification of p53,ATM,CSP12,D13S25,RB1,and increase or decrease of IgG,IgM,IgA.3.Univariate analysis showed that the number of affected lymph nodes?3,late Rai stage,late Binet stage,p53 loss,splenomegaly,platelet<100�109/L,lactate dehydrogenase increase,CD38 positive,and ZAP70 positive were the poor prognostic factors.Multivariate analysis showed that the late stage of Binet was an independent prognostic factor.The use of Binet stage in the initial diagnosis can help evaluate the prognosis of patients with CLL to better guide treatment and improve survival.