Clinical profile, treatment outcome and predictors of treatment outcome of Chronic Lymphocytic Leukemia (CLL) patients at Tikur Anbessa Specialized Hospital:A three-year retrospective study
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Date
2023-03
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Addis Ababa University
Abstract
Background
Chronic Lymphocytic Leukemia (CLL) is the most prevalent type of leukemia worldwide. So far there are
only few studies conducted in this area in Ethiopia. Understanding of the current clinical presentation as
well as outcome of treatment in CLL patients is relevant in improving diagnostic as well as treatment
modalities of this disease in developing countries such as Ethiopia.
Objective
The main objective of this study is to describe the clinical profiles and treatment outcomes of Chronic
Lymphocytic Leukemia (CLL) patients at Tikur Anbessa Specialized Hospital.
Methods
A retrospective cross sectional design was used to conduct the study at Tikur Anbessa Specialized Hospital
from September 1, 2021 to December 31, 2022. Structured questionnaire was used to collect data from
electronic medical recording system of all adult Chronic Lymphocytic Leukemia (CLL) patients seen at
Hematology clinic from September 2019 to August, 2022. Descriptive as well as correlation analysis were
done using the software Statistical Package for the Social Science (SPSS) data editor version 25 .0.
Result
There were a total of 169 Chronic Lymphocytic Leukemia (CLL) patients included in the study. The male-
to-female ratio was 1.91:1. The mean age at diagnosis was 57 years. Majority of patients were from the
capital Addis Ababa. The commonest presenting symptom was swelling at lymph node site which was
found on 58.4% and the commonest presenting sign was palpable lymphadenopathy in 74%. The
commonest laboratory finding was leukocytosis (91.5%). Majority of patients had Rai stage 2 disease
(34.7%) followed by Rai stage 1 disease in 24%. Only 33% of the patients required CLL directed therapy
with the commonest indication for treatment being Rai stage 3 or 4 disease. The commonest first line
regimen used was BR regimen. Total response rate to first line regimen was 76.1%. The relapse rate among
responders was 57.1%. The lost to follow up rate was very high, 55.6% and the proportion of confirmed
death was18.3% from the whole cohort. Age, sex and treatment regimen were among the factors affecting
treatment response and sex was the major factor affecting relapse rate and progression free survival with
female patients having better response, lower risk of relapse and longer progression free survival than
males. Overall survival was affected only by age with patients younger than 50 years having better overall
survival.
Conclusion
The clinical presentation of patients with CLL in our set up is similar with most centers worldwide but with
younger mean age at presentation. The proportion of advanced disease seems to have lowered compared
from previous findings. Response to therapy are comparable with other similar set ups. Age, sex and type
of regimen are major factors affecting response to treatment.
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Keywords
Lymphocytic Leukemia