Utilization of Chronic Lymphocytic Leukaemia International Prognostic Index (CLL-IPI) for Prognostic Stratification in Newly Diagnosed Chronic Lymphocytic Leukaemia Patients

Abstract

Background: Chronic lymphocytic leukemia is detected through identification of clonal B - lymphocytes exhibiting specific immunological phenotype in peripheral blood. Over past years, advancements in its understanding have yielded numerous factors that enhance prognostic assessments beyond traditional clinical staging systems. The introduction of innovative treatments has transformed its management. CLL-IPI serves as an index that consolidates key prognostic indicators, including IGHV gene analysis and FISH for del[17p]. Methods: Our objective was to score and risk stratify newly diagnosed patients presenting to AFIP, Rawalpindi from Dec 2021 - 2023 according to CLL-IPI. Five variables of 124 patients [serum ?2- microglobulin levels, IGHV region gene rearrangement status, del[17p] by FISH, clinical stage, age] were noted. The sum of these scores identified patients into very high risk group (7-10), high (4–6), intermediate (2-3) and low risk groups (0-1 points). Results:  Mean patients age was 61 years (Range 27-86). 20 (16%) were females and 104 (84%) were males. On clinical staging, 36 (29.0%) in Rai stage 0, and 24 (19.3%) in Rai stage I, 04 (3.2%) patients in Rai stage II, 44 (35.5%) in stage III, 8 (17.3%) in Rai stage IV. Del[17p] was positive in 16 (14%) and 44 (35.5%) patients had un-mutated IGHV gene rearrangement. The CLL-IPI score identified 32 (26%) patients having high risk and 8 (6%) with very high risk, 28 (23%) patients with low risk, 56 (45%) with intermediate risk respectively. Conclusion: In our study, most patients were found to have intermediate risk, while the very high-risk subgroup had the fewest. Each subgroup necessitates distinct management strategies, which are associated with different overall survival rates over a five-year period. The application of CLL-IPI will enhance prognostic stratification and aid tailored management in clinical settings.