KRONİK LENFOSİTİK LÖSEMİ’DE TANI ANINDA HİPOGAMMAGLOBULİNEMİ SAĞKALIM VE ENFEKSİYON RİSKİ ÜZERİNDE ETKİLİ MİDİR?

Öz

Amaç: Kronik Lenfositik Lösemi (KLL) en sık görülen lösemi alt tipidir. KLL’de en önemli mortalite ve morbidite nedenlerinden biri enfeksiyonlardır. Hipogammaglobulinemi, enfeksiyon riskini arttıran durumlar arasındadır. Bu çalışmada, merkezimizde KLL tanısı alan ve tanı anında hipogammaglobulinemisi tespit edilen hastaların enfeksiyon gelişimi ve sağkalım verileriyle değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: Bu çalışmaya 2000-2014 yılları arasında Ankara Üniversitesi Tıp Fakültesi Hematoloji Bilim Dalında KLL tanısı almış 75 hasta dahil edilmiştir. Hastaların özellikleri, geçirdikleri enfeksiyonlar, tedavileri ve sağkalım bilgilerine geriye dönük olarak hasta dosyalarından ulaşılmıştır. Kategorik veriler, Ki-kare testiyle karşılaştırılmıştır. p<0.05 değeri anlamlı kabul edilmiştir. Genel sağkalım, Kaplan-Meier metoduyla belirlenmiştir.

Bulgular: Tanı anında 75 hastanın ortanca yaşı 59’dur (aralık: 32-85). En az 1 immunoglobulin alt tipi düzeyinde düşüklük 32 hastada (%43) tespit edilmiştir. Herhangi bir immunoglobulin düzeyinde düşüklük saptanan hastaların yaş ortalaması, hipogamaglobulinemi saptanmayanlardan istatistiksel olarak anlamlı yüksektir (62 ile 57, p=0.03). Tanı anından itibaren birinci yılda orta-ağır enfeksiyon geçiren 26 hasta (%35) mevcuttur. En az 1 immunoglobulin alt tipi düzeyinde düşüklük tespit edilen hastaların orta-ağır enfeksiyon riskinde hipogamaglobulinemisi olmayan hastalara göre anlamlı bir fark saptanmamıştır (10 (%38) ile 16 (%62), p=0.63). 5 yıllık genel sağkalım, normal ve düşük immunoglobulin olan hastalarda sırasıyla %93 ve %83’tür (p=0.15)

Sonuç: KLL’de tanı anında herhangi bir immunoglobulin düzeyinde düşüklük tespit edilen hastalarda enfeksiyon riski açısından anlamlı bir artış gözlenmemiştir. Genel sağkalım immunoglobulin düzeyleri normal olan hastalarla benzerdir.

Anahtar Kelimeler

• Kronik Lenfositer Lösemi,hipogammaglobulinemi,enfeksiyon

Is Hypogammaglobulinemia Present at Diagnosis of Chronic Lymphocytic Leukemia effective on Survival and Risks of Infection?

Öz

Objective: Chronic lymphocytic leukemia (CLL) is the most common subtype of leukemia. One of the most important causes of mortality and morbidity in CLL is infections. Hypogammaglobulinemia is among the conditions that increase the risk of infection. In this study, it was aimed to evaluate the patients with CLL who had hypogammaglobulinemia at the time of diagnosis, development of infections and survival data.

 Material and Methods: Seventy-five patients with CLL who admittted between 2000 and 2014 at the Department of Hematology, Ankara University School of Medicine were included in this study. Patient characteristics, infections, treatment and survival data were obtained retrospectively from patient files. Categorical data were compared with Chi-square test. p value <0.05 was considered significant. Overall survival (GS) was determined by the Kaplan-Meier method.

Results: At the time of diagnosis, the median age of 75 patients was 59 (range: 32-85). At least 1 immunoglobulin subtype level was detected as low in 32 patients (43%). The mean age of patients with low immunoglobulin levels was statistically significantly higher than those without hypogammaglobulinemia (62 to 57, p=0.03). There were 26 patients (35%) who had a moderate to severe infection in the first year after diagnosis. Patients with low levels of at least 1 immunoglobulin subtype had no significant difference in the risk of moderate to severe infections compared to patients without hypogammaglobulinemia (10 (38%) and 16 (62%), p=0.63). The 5-year overall survivals were 93% and 83% (p=0.15) in patients with normal and low immunoglobulin, respectively.

Conclusion: There was no significant increase in risk of infection in patients with low immunoglobulin levels at the time of diagnosis in CLL. Overall survival is similar to that of patients with normal immunoglobulin levels.

Anahtar Kelimeler

• Chronic Lymphocytic Leukemia,hypogammaglobulinemia,infection

Kaynakça

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