Presenting Features and Outcome of Elderly Chronic Lymphocytic Leukemia Patients Diagnosed at the Age of 80 Years or Above. An ICLLSG Study.

Abstract 4620

Chronic lymphocytic leukemia (CLL) is the most common leukemia of the elderly people in the western world. Its age-adjusted incidence rate is about 4.1 per 100,000 men and women per year. CLL increases exponentially with age and for patients above the age of 80 the CLL incidence rate increases to >20 per 100,000 per year. The clinical characteristics and outcome of CLL patients diagnosed at age 80 or above are unknown. The Israel Chronic Lymphocytic Leukemia Study Group reviewed retrospectively the records of 214 such patients diagnosed between the years 1979–2009 in 7 medical centers (118 males, 96 females; mean age: 84 years, range; 80–94). 153 (71%) were Ashkenazi Jews, 43 (20%) were Sephardic Jews, and 3 (1.4%) were Arabs. 104 (48%) were referred due to routine blood analysis and 80 (37%) due to disease manifestations. At diagnosis 120 (56%) had Rai stage 0, 67(31%) Rai stages I and II, and 27(13%) Rai stages III and IV. The mean hemoglobin level was 12.2g/dL (range 5.8–17.3), mean WBC 33,241/μ L (range 6,100-400,000) and mean platelets of 194,622/μ L (range 56,000-617,000). Lymphadenopathy was noted in 33% and splenomegaly in 22%. LDH at diagnosis was elevated in 26% of the patients. 161 patients (75%) were on follow-up only without any treatment. Fifty three patients received treatment for the CLL (25%). Treatment consisted of chlorambucil and or prednisone in 36 patients, COP (cyclophosphamide, vincristine and prednisone) in 6 patients, CHOP (cyclophosphamide, adriamycine, vincristine and prednisone) in 5 patients, FC (fludarabine and cyclophosphamide) in 3 patients and RCOP (rituximab and COP) in 2 patients, 1 patient received irradiation. By June 2010,155 patients (72%) have died with a mean overall survival of 68±5 months, median 56±5.4 months and 5 years survival of 47.2%±3.6. In univariate analysis a better survival was associated with younger age (the mean survival of patient age 80–84 years at diagnosis was 76±6.3 months, median 71±5.8 months compared to mean survival of 48.8±4.8 months and median 43±9.3 months for patients ≥85 years old at diagnosis, p=0.002), Rai stage (the mean survival of patients diagnosed at Rai stage 0 was79.5±8.5 months, median 62±6.5 months compared to mean of 55.7±6.2 months, median 47±7.6 months for patients diagnosed at Rai stages I and II, p=0.023), WBC count at diagnosis (the mean survival of patient with WBC count at diagnosis ≤30,000/μ L was 77±7.6 months, median 62±6.1 months compared to mean survival of 51.8±6.7 months, median 32±8 months in patients diagnosed with a WBC >30,000/μ L, p=0.015), β2 microglobulin levels (the mean survival of the 39 patients with β2 microglobulin level at diagnosis < 3mg/L was 103±19.6 months, median 70±13 months compared to mean of 50.2±7.6 months, median 39±8 months in the 28 patients with β2 microglobulin levels ≥ 3 mg/L, p=0.006), reason for diagnosis (the mean survival of patients diagnosed due to routine blood counts was 88.4±11.2 months, median 72±4.8 months, compared to 43.2±4.6 and 27±6.8 in patients diagnosed due to disease manifestations, p< 0.001), and CD38 level (the mean survival of 87 patients with CD38 levels ≤30% was 81.1±7.9 months, median 72±4.6 months compared to 52±8.9 32±6.9 months respectively in the 24 patients with CD 38 levels >30 %, p=0.036). No correlation was found between overall survival and patients’ gender, receiving or not chemotherapy, year of diagnosis before or after 2000, or ethnicity (Ashkenazi Jews vs. Sephardic Jews). Multivariate analysis using Cox regression analysis found younger age, low WBC count, and routine blood test as the reason for diagnosis as 3 independent good prognostic factors (HR 1.8, 1.6, 1.9 respectively). CLL patients diagnosed at the age of 80 or more can still expect to live long life.