Introduction

Chronic lymphocytic leukemia (CLL) is the most common leukemia in adults in Western countries, with incidence increasing with age. Its clinical course is highly variable, ranging from indolent forms that do not require immediate treatment to aggressive presentations that demand early intervention. In recent years, both diagnostic studies and new treatments incorporating targeted agents have significantly transformed the way this disease is treated. In developing countries, including Paraguay, the epidemiology and treatment patterns of CLL have been poorly described. To address these gaps, we conducted a retrospective multicenter study focusing on clinical characteristics, treatment modalities, and survival outcomes for CLL in Paraguay.

Methods

We conducted a retrospective cohort study of patients (pts) aged ≥18 years with chronic lymphocytic leukemia (CLL) newly diagnosed between 2001 and 2024 at four centers in Paraguay. Patient data were manually extracted from medical records using a standardized form. The primary endpoint was overall survival (OS), defined as the time from diagnosis to death from any cause, while the secondary endpoint was progression-free survival (PFS), defined as the time from diagnosis to relapse, disease progression, or death from any cause. Kaplan-Meier and Log-rank tests were used to estimate and compare survival probabilities.

Results

A total of 255 patients diagnosed between 2014 and 2024 were enrolled. The median age at diagnosis was 65 years (54% > 60 years; range 30-93), with a slight male predominance (53.7%). RAI stage 1 (39.5%) and Binet stage A (56.1%) were the most common clinical presentation stages. The vast majority of patients (81.6%) did not undergo FISH or karyotyping due to lack of coverage. Among patients who required treatment, the most commonly used regimens were FCR (22.2%), R-CHOP (20%), R-COP (18%), R Bendamustine (15%), Obinutuzumab Venetoclax (12%), and BTK inhibitors (10%). The response to treatment was available in 110 patients, with an overall response rate to any approach of 88% and a CR rate of 45%. Higher CR rates were observed in the Obinutuzumab Venetoclax subgroup (50%).

With a median follow-up of 100 months (80-120), median OS and PFS were not reached in all patients.

Conclusion

In this large cohort of patients with chronic lymphocytic leukemia in Paraguay, our findings reveal the problem of lack of access to molecular studies. We believe that this limitation does not allow patients to be treated according to their risks, which is why we see a high percentage of patients still receiving immunochemotherapy, which is not in accordance with international guidelines. Knowing these data allows us to increase efforts to improve access to diagnosis and targeted treatments in our country.

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2025
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