Co-Morbidities and Treatment Decisions in Newly Diagnosed CLL Patients Cross All Disease Stages in Kurdistan Region-Iraq

Abstract

Background: Chronic lymphocytic leukemia (CLL) is one of the most common leukemias in Iraq as in other areas of the world, but with younger age involvement in comparison with western population. As in all hematological malignancies, risk stratification of patients with CLL is an essential step in treatment planning.

Aim of study: To evaluate the daily life activity and co-morbidity effects on choosing appropriate lines of treatment for the best interest of CLL patients according to cumulative illness rating scale index (CIRS).

Patients & Methods: A cross sectional review study conducted in three hematology- oncology health care facilities in Kurdistan region – Iraq, (Nanakaly hospital - Erbil, Hiwa hospital in Sulaimani and Azadi hematology oncology center in Duhok) throughout the duration of three years period starting from 1^st of January, 2018 till 31^st of December, 2020 using a sample of 250 patients diagnosed to have CLL. The CIRS index was applied by the researchers through measuring its score for 14 body systems and calculating the final cumulative index score for each patient.

Results: In the current study, 159 CLL patients (63.6%) in Kurdistan region were treated, while 91 of them (36.4%) were treatment naïve. There was a highly significant association between advanced Rai staging of CLL patients and treatment provision (p<0.001). A highly significant association was observed with Binet stage C and among patient treatment group (p<0.001). No significant differences were observed between treatment and non-treatment groups of CLL patients regarding total CIRS index score (p=0.06). In the present study, 52 (20.8%) of the treated patients were dead, in comparison to 19.25 (7.7%) of the treatment naïve ones.

Conclusions: The staging and risk stratification of CLL patients is an important initial step in planning their management. Treatment planning of CLL patients in Kurdistan region depends on either Rai and/or Binet staging, but the CIRS was not widely applied previously for further in-depth stratification and disease management.

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