COMPARATIVE EFFECTIVENESS OF CHRONIC LYMPHOCYTIC LEUKEMIA THERAPY: THE EXPERIENCE OF THE ALMATY CLINIC

Abstract

Relevance: Clinical and genetic heterogeneity of chronic lymphocytic leukemia (CLL) influences therapy choices and outcomes. Cytogenetic and biological markers are crucial for disease staging, therapeutic decision-making, and prognosis. Real-world data comparing chemo-, immunotherapy, and targeted regimens are essential for refining patient management strategies. 

The study aimed to evaluate the comparative effectiveness of chemotherapy, immunotherapy, and targeted therapy in patients with chronic lymphocytic leukemia, taking into account cytogenetic parameters, age, and stage of the disease.

Methods: This retrospective cross-sectional study included 114 CLL patients treated at the City Clinical Hospital No. 7 (Almaty, Kazakhstan) between 2001 and 2024. Patients received either chemoimmunotherapy (FC, FCR, CR, COP, chlorambucil) or targeted regimens (BTK/PI3K inhibitors, anti-CD20 antibodies). Primary endpoints were progression-free survival (PFS) and overall response rate (ORR). 

Results: Distribution of patients with CLL by disease stage: stage B – 59.6% (n = 68), stage A – 25.4% (n = 29), stage C – 9.6% (n = 11), stage not established – 5.4% of cases (n = 6). According to cytogenetic testing (n = 63), the most frequent abnormality was del(13q14) (33%, n = 21), either isolated or combined with other aberrations. Del(11q22.3) was detected in 17.5% (n = 11), trisomy 12 in 11% (n = 7), and TP53 mutations in 6.3% (n = 4). Among treatment regimens, the highest median PFS was observed with FC (46.6 months), CR (45 months), and ibrutinib (32.1 months). In patients receiving ibrutinib in later therapy lines (n=10), comparable complete response rates and disease stabilization were achieved. 

Conclusion: In real clinical practice, targeted therapy demonstrates superior PFS and better tolerability in high-risk patients and in those pretreated with one or more prior lines of therapy, whereas chemotherapy remains a viable option for selected subgroups (younger patients, IGHV-mutated, favorable cytogenetics). Treatment personalization based on genetic profiling improves outcomes in CLL. Expanding access to comprehensive genetic testing is critical to further enhance prognosis and survival.