Prevalence and diagnosis of patients with Chronic Lymphocytic Leukemia in the Extreme South of Bahia, Brazil

Authors

DOI:

https://doi.org/10.33448/rsd-v12i3.40483

Keywords:

Chronic lymphocytic leukemia; Prevalence; Hematological changes; Immunophenotypic changes.

Abstract

Chronic Lymphocytic Leukemia (CLL) is a proliferative B-cell neoplasm, promoting enlargement of the spleen, liver and lymph nodes, affecting mainly white males, with a high incidence after 65 years of age. Thus, we aimed to identify the prevalence of patients with CLL in the Extreme South of Bahia, analyzing the markers of laboratory diagnostic protocols. The present study is a retrospective cohort from 2015 to 2019, under CAAE Approval: 5.336.684 from CEP/CONEP, of medical records of patients with LLC performed at the High Complexity Oncology Unit - UNACON, located in the municipality of Teixeira de Freitas, Bahia. Thus, the results allowed us to find that, according to information from DATASUS, of the 82 diagnosed cases of chronic lymphoproliferative diseases, between 2015 and 2019 from the Extreme South of Bahia, six cases were of LLC. In the medical records there were clinical-epidemiological characteristics, 66.7% were in male patients; with 50% white and brown individuals, presenting lymphocytosis, thrombocytopenia and normocytic-normochromic anemia (50%), one case (16.7%) carrying Gumprecht's Patches and one case (16.7%) presenting CD79 and IGV15. As for the conclusions, it was seen that the most used diagnostic markers comprised the performance of hematological tests such as hemogram and myelogram, including hematological/biochemical characteristics, especially lymphocytosis, leukocytosis, thrombocytopenia, anemia, with emphasis on immunophenotypic characteristics, by CDs 19 and 79, being the low prevalence in the Far South of Bahia of only 7.3% of cases diagnosed with LLC.

References

ACS. (2022). Key Statistics for Chronic Lymphocytic Leukemia: American Cancer Society.

ACS. (2023). Key Statistics for Chronic Lymphocytic Leukemia: American Cancer Society.

Albi, E. et al. (2022). Are we finally getting personal? Moving towards a personalized approach in chronic lymphocytic leukemia. Seminars in Cancer Biology. 84, 329-338. ISSN 1044-579X. https://doi.org/10.1016/j.semcancer.2022.01.009.

Amaya-Chanaga, C. I. & Rassanti, L. Z. (2016). Biomarkers in chronic lymphocytic leukemia: clinical applications and prognostic markers. Best Pract Res Clin Haematol. 29(1), 79- 89.

Andrade, T. A., & Ferreira, G. R (2020). Leucemia Linfocítica Crônica- B (LLC-B): Uma Revisão da Abordagem Terapêutica Monoclonal. Revista NBC – 10(19).

Antunes, S. R. et al. Hematologia Clínica. SAGAH, 2019. v. 1.

Bahia (2016). Bahia. (2016). Plano Estadual de Saúde 2016-2019./ Secretaria da Saúde do Estado da Bahia (SESAB). Revista Baiana de Saúde Pública.

Bahia. (2019). Relatório Anual de Gestão (RAG). Laboratório Central de Saúde Pública (LACEN). Teixeira de Freitas, Bahia. Governo do Estado da Bahia. Secretaria da Saúde do Estado da Bahia. 9-12. 32p

Bahia. (2021). Relatório Anual de Gestão (RAG). Governo do Estado da Bahia. Secretaria da Saúde do Estado da Bahia. 2021. 372-379. 382p

Binet, J. L, et al., (1981). A clinical staging system for chronic lymphocytic leukemia: prognostic significance. Cancer. 1981,40(2):855-64

Brasil. (2013). Protocolos clínicos e diretrizes terapêuticas em Oncologia. Centro Estadual de Oncologia – Cican– Bahia: Ministério da Saúde. Secretaria de Atenção à Saúde.

Brasil.(2020). Centro de Assistência de Alta Complexidade em Oncologia CACON – Bahia: Secretaria de Atenção à Saúde. Ministério da Saúde. 2020.

Brown, J. R. et al. (2023). Zanubrutinib or Ibrutinib in Relapsed or Refractory Chronic Lymphocytic Leukemia.2023.NenglJMed2023, 388:319-332DOI: 10.1056/NEJMoa2211582

Chang Chih-Chun et al. (2016). Clinical significance of smudge cells in peripheral blood smears in haematological malignancies and other diseases. Asian Pac J Cancer Prev. 2016, 17(4):1847-50. Doi: 10.7314/apjcp.2016.17.4.1847. Disponível em < https://pubmed.ncbi.nlm.nih.gov/27221863/ >. Acesso em 13 out 2022.

Chauffaille, M. L. L. F., & Campos, M. G. V. Leucemia Linfoide Aguda. In: Figueiredo, M. S., Kerbauy, J., Lourenço, D. M. (2010). Guias de Medicina Ambulatorial e Hospitalar da UNIFESP-EPM: Hematologia. UNIFESP: São Paulo, SP: Nestor Schor, 2010. cap. 46, p. 373-382.

Chowdhury, Z. et al. (2021). Chronic lymphocytic leukaemia/prolymphocytic leukaemia or B-cell prolymphocytic leukaemia? The importance of integrating clinical-morphological and immunophenotypic findings in distinguishing chronic lymphoproliferative diseases with circulating phase. Autops Case Rep. 2021, 11:e2020196.

Coelho, A., Michels, A. C & Fáveri. A. (2021). Perfil epidemiológico dos pacientes com leucemia linfoide crônica na região do Alto Vale do Itajaí e a prevalência das mutações genéticas. Hematology, Transfusion and Cell Therapy. 2021. https://doi.org/10.1016/j.htct.2021.10.202.

Concepción F., Quintero S. Y. & Romero, A. (2021). Actualidades terapéuticas en la leucemia linfoide crónica. Rev Cubana Hematol Inmunol Hemoter, Ciudad de la Habana 37(3), e1344.

Condoluci A. et al. (2020) International prognostic score for asymptomatic early-stage chronic lymphocytic leukaemia. Blood, 2020, 135, 1859-186.

Dong, Y. et al. (2020). Leukemia incidence trends at the global, regional, and national level between 1990 and 2017. Exp Hematol Oncol. 2020, Jun 19,9:14. 10.1186/s40164-020-00170-6.

Failace, R. & Fernandes, F. (2015). Hemograma: manual de interpretação. (6a ed.), Artmed, 2015

Figueiredo, M.S. et al. (2010). Guias de Medicina Ambulatorial e Hospitalar da Unifesp. Hematologia. Editora Manole, 2010

Frassetto, et al., (2021). Câncer de medula óssea: perfil-clínico epidemiológico no Brasil entre 2009 e 2019. Hematology, Transfusion and Cell Therapy. Volume 43. Supplement 1. 2021. https://doi.org/10.1016/j.htct.2021.10.860

Gaidano, V. et al., (2020). A clinically applicable approach to the classification of B-Cell non-Hodgkin lymphomas with flow cytometry and machine learning. Cancers (Basel). 2020,12(6):1684. https://doi.org/10.3390/cancers12061684

Geller, M., & Scheinberg, A. M. (2015). Diagnóstico e Tratamento de doenças Imunológicas. 2ª Edição. Editora Guanabara Koogan-ELSEVIER, 2015

Giudice, V. et al. (2022). Implementation of the International Prognostic Index with flow cytometry immunophenotyping for better stratification. Eur J Haematol. 2022 Nov,109(5):483-493.

Gonçalves, R. P. (2009). Avaliação do perfil hematológico de pacientes com leucemia linfocítica crônica (LLC-B) em um hemocentro estadual. Rev. Bras. Hematol. Hemoter. 2009,31(4):228-234

Hallek M. (2020). Chronic lymphocytic leukemia: 2020 update on diagnosis, risk stratification, and treatment. American Journal of Hematology. 2020. 94:1266-1287

Hallek, M, & Al-Sawaf, O. (2021). Chronic lymphocytic leukemia: 2022 update on diagnostic and therapeutic procedures. Am J Hematol. 2021 Dec 1,96(12):1679-1705. 10.1002/ajh.26367.

Hasserjian, R. P. (2023). This Year’s Best in Hematology Diagnosis: Mapping the Heterogeneity of Chronic Lymphocytic Leukemia. Hematologist, 2023. < https://doi.org/10.1182/hem.V20.1.202313

Ibge. (2019). Pesquisa Regional do Extremo Sul Baiano: Teixeira de Freitas-Bahia. Bahia: Instituto Brasileiro de Geografia e Estatística - IBGE. 2019.

Inca (2017). Estudo Nacional da Incidência de neoplasias de caráter linfoide e mieloide no país. Instituto Nacional de Câncer José Alencar Gomes da Silva. São Paulo: INCA, 2017.

Inca. (2020). Estimativa 2020: incidência de câncer no Brasil. Instituto Nacional do Cancer José Alencar Gomes da Silva. Estimativa de casos novos de câncer para o triênio 2020-2022. Rio de Janeiro, RJ, INCA, 2019.

Jacque, N., & Leblond, V. (2019). La leucémie lymphoïde chronique: mise au point. La Presse Médicale. 2019. Doi: https://doi.org/10.1016/j.lpm.2019.07.019.

Jain, N., & O’brien, S. (2015). Initial treatment of CLL: integrating biology and functional status. Blood 2015, 126 (4): 463–470. doi: https://doi.org/10.1182/blood-2015-04-58506

Korubo, K.I., Okite, P.U. & Ezeugwu, S.I. (2021). Chronic Lymphocytic Leukemia: Prognostic Factors at Presentation in a Resource-Limited Center. JCO Glob Oncol. 7:56-62. 10.1200/GO.20.00276.

Marrero, T. Y., Suárez, M.V. & Pérez, D. Y. (2020). Diagnóstico por citometría de flujo de paciente con leucemia linfoide crónica. Revista Cubana de Hematología, Inmunología y Hemoterapia, 2020, 36(4): e 1244.

Matutes, E. et al. (2010). Diagnostic issues in chronic lymphocytic leukaemia (CLL). Best Practice & Research Clinical Hematology. 23, 3-20. < http://www.bprch.com/article/S1521-6926(10)00002-2/abstract >.

Montserrat, E., & Moreno, C. (2008). Chronic lymphocytic leukaemia: a short overview. Annals of Oncology. Barcelona, 19, 320-325, https://pubmed.ncbi.nlm.nih.gov/18790975/

Moreno C. et al. (2019). Ibrutinib plus obinutuzumab versus chlorambucil plus obinutuzumab in the first-line treatment of chronic lymphocytic leukaemia (iLLUMINATE): a multicentre, randomised, open-label phase 3 study. Lancet Oncol. 2019, 20(1):43-56

Muñoz-Novas, C. et al. (2018). The International Prognostic Index for Patients with Chronic Lymphocytic Leukemia Has the Higher Value in Predicting Overall Outcome Compared with the Barcelona-Brno Biomarkers Only Prognostic Model and the MD Anderson Cancer Center Prognostic Index. Bio Med research international, 2018, 9506979. https://doi.org/10.1155/2018/9506979.

Oliveira, R. A. G. (2014). Hemograma: como fazer e interpretar. Editora:LMP, 2014. 270p.

Owen, C. et al. (2023). Canadian evidence-based guideline for frontline treatment of chronic lymphocytic leukemia: 2022 update, Leukemia Research, Volume 125, 2023,107016, https://doi.org/10.1016/j.leukres.2023.10701

Paula, M. I. P. (2009). Gestão da política de saúde de Teixeira de Freitas, Ba: um estudo de caso. Revista Mosaicum. 20-31.

Pflug, N. et al. (2014). Development of a comprehensive prognostic index for patients with chronic lymphocytic leukemia. Blood, 2014. 124(1), 49–62. https://doi.org/10.1182/blood-2014-02-556399.

Rai, K. R., et al. (1975). Clinical staging of chronic lymphocytic leukemia. Blood. 1975,46(2):219-34.

Rai, K.R, & Jain, P. (2016). Chronic lymphocytic leukemia (CLL)-Then and now. Am J Hematol, 2016. 91:330/1975,46(2):219-234.

Robbe, P. et al. (2022). Whole-genome sequencing of chronic lymphocytic leukemia identifies subgroups with distinct biological and clinical features. Nat Genet 54, 1675–1689 (2022). https://doi.org/10.1038/s41588-022-01211-y.

Rodrigues, C. A. et al. (2016). Diagnosis and treatment of chronic lymphocytic leukemia: recommendations of the Brazilian Group for Chronic Lymphocytic Leukemia. Brazilian Journal of Hematology, Hemotherapy and Cell Therapy, 2016. 3 8(4):346-357.

Sall, A. et al. (2016). Characteristics of chronic lymphocytic leukemia in Senegal. BMC Hematol, 2016, 23,16:10.https://doi.org/10.1186/s12878-016-0051-y8.

Selene, I. et al. (2023). A Tale of Two Hematological Malignancies: CML Followed by CLL in the Same Patient. AIM Clinical Cases.2023,2:e220116. doi:10.7326/aimcc.2022.0116

Shimoyama, M. (1991). Diagnostic criteria and classification of clinical subtypes of adult T-cell leukaemia-lymphoma. A report from the Lymphoma Study Group (1984-87). Br. J. Haematol, 79, 428–437. doi: 10.1111/j.1365-2141.1991.tb08051.

Silva, L.B. et al. (2009). Evaluation of the hematologic profile of patients with chronic lymphocytic leukemia (CLL-B) in a state hemocentre. Rev. bras. Hematol. Hemoter., 2009. 31(4):228-234.

Suárez-Cabrera, A. et al. (2022). Diagnosis Has Prognostic Value in Patients with Chronic Lymphocytic Leukemia including at Early Stages. Diagnostics, 12, 1802. https://doi.org/ 10.3390/diagnostics12081802.

Theodoro, F.C.M et al., (2022). Clinical-laboratorial markers in the prognostic investigation of Chronic Lymphocytic Leukemia. Hematology, Transfusion and Cell Therapy, 2022, https://doi.org/10.1016/j.htct.2022.09.960.

Vasconcelos, Y. (2005). Marcadores de prognóstico na leucemia linfocítica crônica. Revista Brasileira de Hematologia e Hemoterapia, 27, 27(4).

Villavicencio, A. et al. (2021). Comorbidities at Diagnosis, Survival, and Cause of Death in Patients with Chronic Lymphocytic Leukemia: A Population-Based Study. Int. J. Environ. Res. Public Health, 2021, 18, 701. https://doi.org/10.3390/ijerph18020701.

Wierda, W. G. et al. (2007). Prognostic nomogram and index for overall survival in previously untreated patients with chronic lymphocytic leukemia. Rev. Blood, 109(11), 4679-4685

Wierda, W. G. et al. (2010). Ofatumumab as single-agent CD20 immunotherapy in fludarabine- refractory chronic lymphocytic leukemia. Journal of Clinical Oncology, 2010. 28:1749- 1755. 10.1200/JCO.2009.25.3187.

Williamson, A.M., & Snyder, L.M. (2016). Wallach: interpretação de exame laboratoriais. 10. ed. Rio de Janeiro: Guanab ara Koogan, 2016. 1250 p.

Yun, X. et al. (2020). Recent progress of prognostic biomarkers and risk scoring systems in chronic lymphocytic leucemia. Biomarker Research, 2020. 8:40 https://doi.org/10.1186/s40364- 020-00222-3.

Zago, M. A. et al. (2013). Tratado de hematologia. Atheneu, 2013.

Published

25/02/2023

How to Cite

RIBEIRO, A. M. .; ALVES, C. C. de S. .; PETINARI, R. B. . Prevalence and diagnosis of patients with Chronic Lymphocytic Leukemia in the Extreme South of Bahia, Brazil. Research, Society and Development, [S. l.], v. 12, n. 3, p. e8312340483, 2023. DOI: 10.33448/rsd-v12i3.40483. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/40483. Acesso em: 25 apr. 2024.

Issue

Section

Health Sciences