The significance of Rai and Binet clinical staging on the survival of chronic lymphocytic leukemia patients in the Kurdistan region of Iraq
Shlan S Muhammad1, Ahmed Khudair Yassin2, Rawand P Shamoon3, Nawsherwan S Mohammed3, Marwa Nadhim Nadhim1, Kawa M Hassan2, Bryar Sabah Rashid4, Shokhan M Mohammad1, Ranan karadagh3, Ghanim S Numan1, Lara Lateef Abdulrahman1, Sana D Jalal5, Zhala O Ahmed4, Hisham A Getta5, Tavan I Mahmood4, Basil K Abdulla6, Dana A Abdullah5, Rozh-hat A Yousif7, Zeki A Mohamed8
1 Department of Adult Hematology, Nanakali Hospital, Erbil, Iraq
2 Department of Internal Medicine, College of Medicine, Hawler Medical University, Sulaymaniyah, Iraq
3 Department of Pathology, College of Medicine, Hawler Medical University, Sulaymaniyah, Iraq
4 Department of Adult Hematology, Hiwa Hospital for Blood Disease, Sulaymaniyah, Iraq
5 Department of Pathology, College of Medicine, University of Sulaymaniyah, Sulaymaniyah, Iraq
6 Department of Hematology, Hiwa Cancer Hospital, Sulaymaniyah, Iraq
7 Department of Adult Hematology-Azadi Centre for Blood Disease, Duhok, Kurdistan Region, Iraq
8 Department of Medicine, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq
Dr. Shlan S Muhammad
Nanakali Hospital, Erbil
Source of Support: None, Conflict of Interest: None
BACKGROUND: Chronic lymphocytic leukemia is an uncommon type of leukemia in Iraq, although many reported cases of chronic lymphocytic leukemia in the Iraqi Kurdistan region are of high risk stage. Staging of chronic lymphocytic leukemia is essential in treatment planning and for disease prognosis. the aims of this study were to find out the difference in patients' survival with early and late clinical stages, and to evaluate CLL outcome in relation to the Rai and Binet staging.
PATIENTS AND METHODS: This retrospective cross-sectional analysis studied 250 patients, 170 male and 80 female, with chronic lymphocytic leukemia who were registered in three hemato-oncology centers in Iraqi Kurdistan for the last 10 years. The diagnosis of the disease was made according to the guideline of the International Workshop Chronic Lymphocytic Leukemia update of the National Cancer Institute. The patients' clinical staging was determined by a senior hematologist based on the clinical and laboratory findings.
RESULTS: The mean age of the patients was 63(±11.8) years, 40% were >65 years. The median survival was 27 months. Elderly patients >65 years had significantly lower mean survival. The Rai staging was distributed as follows: stage 0 (24.8%), stage I (12.8%), stage II (30.8%), stage III (9.6%) and stage IV (22%). The median survival was significantly higher among patients with Rai stage 0 comparing to patients with advanced stages (P<0.001). The Binet stage was distributed as follows: stage A (47.2%), stage B (26.4%) and stage C (26.4%). The median patients' survival was significantly higher among patients with Binet stage A comparing to those with Binet stage C (P<0.001).
CONCLUSIONS: The survival of patients with chronic lymphocytic leukemia strongly related to the clinical stages of both staging systems.