CLL-366 Comorbidities and Treatment Decisions in Newly Diagnosed CLL Patients Across All Disease Stages in the Kurdistan Region of Iraq

Abstract

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 to the west. As in all hematological malignancies, risk stratification is essential for treatment planning. To evaluate the daily life activity and comorbidity effects on choosing appropriate lines of treatment for CLL patients according to the Cumulative Illness Rating Scale (CIRS) index. A cross-sectional study was conducted in 3 hematology-oncology healthcare facilities in the Kurdistan region of Iraq in a 3-year period, from January 1st, 2018, to December 31st, 2020. The CIRS index was used to measure scores for 14 body systems and calculate the cumulative index score for each patient. The study participants were all cases of CLL admitted to the 3 abovementioned centers. Diagnosis was according to the International Workshop on CLL. All newly diagnosed, treatment-naïve CLL patients were included. Patients with missing data or other hematological malignancy were excluded. After eligibility criteria were applied, 250 CLL patients were selected and enrolled in this study. Data were collected from saved patient records, patients were contacted, and the requested data were collected directly using a questionnaire. Both demographic and clinical characteristics were included: age, gender, socioeconomic status, occupation, body mass index, patient staging (Binet staging, Rai staging, and CIRS for advanced stage, whichever applied), treatment indication, survival duration, and outcome. In this study, 159 patients (63.6%) received treatment, whereas 91 (36.4%) remained treatment naïve (wait & watch). A highly significant association was found between advanced Rai staging and treatment provision (P<0.001). A similar association was observed between Binet stage C and the treatment group (P<0.001). A weak but statistically non-significant relation was observed between the treatment and non-treatment groups regarding the total CIRS index score (P=0.06). The staging and risk stratification of CLL patients is an important initial step in planning their management. Treatment planning of CLL patients in the Kurdistan region depends on either Rai and/or Binet staging; however, the CIRS has not yet been widely applied for further in-depth stratification and disease management.