Abstract
Abstract 4134
New available diagnostic methods could specify the diagnosis of leukemias and new drugs can improve survival of pts. with malignancy. However till today clinical manifestation continues to be the key point in diagnostic procedure of these diseases and time from the first symptoms to define diagnosis and to start of anticancer treatment is often critical for pt's. prognosis.
Documentation of 1007 consecutive pts. referred to 3 hematological centers in Czech Republic with diagnosis of the 6 most frequent leukemias between 2004-3/2009 was analyzed. Special consideration was addressed to clinical and laboratory findings and pt's. complaints before defining the diagnosis in hematological center.
In 1007 pts. – 439 (44%) females/ 568 (56%) males – diagnosis of leukemia was established [ALL – 106 (11%), AML - 369 (37%), APL - 74 (7%), HCL - 41 (4%), CML - 123 (12%), CLL - 294 (29%)]. Median age at time of diagnosis was 60 years (ALL - 47, AML - 62, APL - 46.5, HCL - 59, CML - 55, CLL – 66).
Leukemia was diagnosed in 599 (59%) after first symptoms occurred and pt. visited doctor and in 408 (41%) cases accidentally. However, this accidental diagnosis occurred only in 24% pts. with acute leukemia (ALL, AML, APL) and vice-versa in 60% of pts. with chronic leukemias.
The frequency of first symptoms described by pts. shows Table 1.
The first subjective symptoms identified by patient
| . | Presence of any symptom at diagnosis . | Character of symptoms . | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Fatigue . | Pain . | Dyspnoe . | Subfebrilia . | Fever . | Lymphadenopathy . | Bleeding . | Infection . | ||
| ALL | 77% | 70% | 56% | 36% | 37% | 10% | 14% | 25% | 30% |
| AML | 76% | 62% | 43% | 34% | 22% | 21% | 7% | 17% | 30% |
| APL | 73% | 68% | 35% | 21% | 7% | 32% | 3% | 75% | 24% |
| CLL | 34% | 20% | 18% | 7% | 3% | 3% | 15% | 2% | 14% |
| CML | 52% | 35% | 31% | 7% | 8% | 7% | 2% | 16% | 11% |
| HCL | 41% | 27% | 29% | 10% | 5% | 15% | 0% | 7% | 24% |
| Total | 59% | 46% | 39% | 21% | 14% | 13% | 8% | 17% | 22% |
| . | Presence of any symptom at diagnosis . | Character of symptoms . | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Fatigue . | Pain . | Dyspnoe . | Subfebrilia . | Fever . | Lymphadenopathy . | Bleeding . | Infection . | ||
| ALL | 77% | 70% | 56% | 36% | 37% | 10% | 14% | 25% | 30% |
| AML | 76% | 62% | 43% | 34% | 22% | 21% | 7% | 17% | 30% |
| APL | 73% | 68% | 35% | 21% | 7% | 32% | 3% | 75% | 24% |
| CLL | 34% | 20% | 18% | 7% | 3% | 3% | 15% | 2% | 14% |
| CML | 52% | 35% | 31% | 7% | 8% | 7% | 2% | 16% | 11% |
| HCL | 41% | 27% | 29% | 10% | 5% | 15% | 0% | 7% | 24% |
| Total | 59% | 46% | 39% | 21% | 14% | 13% | 8% | 17% | 22% |
The first known objective findings and the first blood count
| . | Clinical finding . | Blood count . | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| B symp-toms . | Dysp-noe . | Bleeding . | Infec-tion . | Lympha-denopathy . | Splen-omegaly . | Hepato-megaly . | Leuko-cytes (109/l) . | Hemo-globin (109/l) . | Thrombo-cytes (109/l) . | Neutro-phyles (109/l) . | |
| ALL | 27% | 36% | 28% | 35% | 20% | 11% | 18% | 15.6 | 99 | 61 | 3 |
| AML | 17% | 27% | 18% | 35% | 9% | 5% | 7% | 11.5 | 89 | 62 | 0.97 |
| APL | 5% | 16% | 77% | 35% | 5% | 0% | 1% | 1.8 | 89 | 33 | 0.25 |
| CLL | 12% | 6% | 2% | 14% | 24% | 10% | 7% | 25.7 | 133 | 181 | 4.47 |
| CML | 15% | 9% | 15% | 13% | 2% | 23% | 8% | 93.3 | 119 | 367 | 43.4 |
| HCL | 12% | 5% | 7% | 22% | 0% | 22% | 2% | 2.4 | 114 | 86 | 0.74 |
| Total | 15% | 18% | 18% | 26% | 13% | 9% | 7% | 20.7 | 112 | 124 | 3.71 |
| . | Clinical finding . | Blood count . | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| B symp-toms . | Dysp-noe . | Bleeding . | Infec-tion . | Lympha-denopathy . | Splen-omegaly . | Hepato-megaly . | Leuko-cytes (109/l) . | Hemo-globin (109/l) . | Thrombo-cytes (109/l) . | Neutro-phyles (109/l) . | |
| ALL | 27% | 36% | 28% | 35% | 20% | 11% | 18% | 15.6 | 99 | 61 | 3 |
| AML | 17% | 27% | 18% | 35% | 9% | 5% | 7% | 11.5 | 89 | 62 | 0.97 |
| APL | 5% | 16% | 77% | 35% | 5% | 0% | 1% | 1.8 | 89 | 33 | 0.25 |
| CLL | 12% | 6% | 2% | 14% | 24% | 10% | 7% | 25.7 | 133 | 181 | 4.47 |
| CML | 15% | 9% | 15% | 13% | 2% | 23% | 8% | 93.3 | 119 | 367 | 43.4 |
| HCL | 12% | 5% | 7% | 22% | 0% | 22% | 2% | 2.4 | 114 | 86 | 0.74 |
| Total | 15% | 18% | 18% | 26% | 13% | 9% | 7% | 20.7 | 112 | 124 | 3.71 |
The first doctor visited by patient and describing abnormality was general practitioner in 48.5%, internist in 21.8%, hematologist in 7.8% and other in 22.4%.
Median time from the first symptoms to define diagnoses was 17 days (ALL – 24, AML – 20, APL – 14, CLL – 16, CML 14, HCL – 31); median time from the first medical examination to define diagnosis was 8 days (ALL – 9, AML – 7, APL – 6, CLL – 12, CML - 6, HCL – 20) and finally the median time from the first examination by hematologist to referring pt. to hematological center was 3 days (ALL – 1, AML – 2, APL – 1, CLL – 32, CML - 8, HCL – 18).
Decision procedure of the first visited doctor was stated as inadequate in 5.5% of pts. – especially in pts with AML (9.4%). Late diagnosis influenced character of treatment and pt's prognosis in 1.5% and 1.6% of pts. respectively – mostly in pts. with acute leukemias (2.9% and 2.8%).
Our analysis showed that the time from the first symptoms until define diagnosis is surprisingly long although pts. with acute leukemia are very often symptomatic at the time of diagnosis. Moreover in these patients with acute leukemias (especially with AML) the diagnostic process was most frequently found as a less adequate and this could influenced the pt's prognosis.
No relevant conflicts of interest to declare.
Author notes
Asterisk with author names denotes non-ASH members.
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