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Are Chronic lymphocytic leukemia blood parameters differing from Other leukemias
subtypes
Ekhlas Alrasheid Abuelfadol1, Mahadi Musa Mohammed Abdalla2, Mohieldin Elsayid3, Ahmed Abdula
Agabeldour4
1Department of Hematology, Faculty of Medical Laboratory Sciences, Kordofan University, El-Obeid, Sudan.
2Ministry of Health, El-Obeid Obstetrics and Gynecology, El-Obeid, Sudan.
3King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for
Health Sciences (KSAU-HS), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Saudi
Arabia.
4Department of Pathology, Faculty of Medicine, Kordofan University, El-Obeid, Sudan.
ABSTRACT
Background: Adults widely acknowledge CLL as a prevalent lymphoproliferative disease, a
hematological malignancy. Thus, the objective of this study was to assess potential differences in blood
parameters among CLL and other subtypes of leukemia. Methodology: The current study utilized
lymphoma data acquired from El-Obeid Oncology Center. The document included data on lymphoma
patients diagnosed between January 2018 and January 2020. The sample included a total of one
hundred patients, of which sixty-one had CLL and forty-nine did not. The traditional BM aspiration
diagnosis for the patient was lymphoma. Results: Within this series, CLL was the most prevalent form
of cancer, followed by CML, NHL, MM, HL, and various other types, making up 61%, 17%, 11%, 6%,
and 3% of cases, respectively. All cases of CLL, MM, and NHL exhibited BM hypercellularity.
Megakaryopoiesis was not observed in ten cases, which consisted of eight (80%) CLL patients and two
(20%) MM patients. We observed megakaryopoiesis in 43 instances, with 60.5% of the cases being CLL
and 30.2% being CML. There were only two instances where CLL showed a decrease in
megakaryopoiesis. We found 34 patients with depressed erythropoiesis. This included CLL in 59% of
cases, CML in 26.5% of cases, and MM in 8.8% of cases. Conclusion: CLL demonstrates a unique set of
hematological parameters when compared to other blood malignancies. CML demonstrates a pattern
that is similar to CLL in different hematological parameters, such as the overall count of white blood
cells.
Keywords: leukemia, lymphoma, blood cancer, hematological parameters, Sudan
------------------------------------------------------------------------------------------------------------------------
Correspondence to: Ekhlas Alrasheid Abuelfadol, Email: ekhlas1988@gmail.com
Cite this article: Abuelfadol EA, Abdalla MMM, Elsayid M, Agabeldour AA. Medical Research Updates 2024;2(1): 1-10. DOI: 0000
INTRODUCTION
Chronic Lymphocytic Leukemia (CLL) is a
prevalent type of leukemia in adults,
characterized by a wide range of clinical
consequences [1]. Although the clinical course
of this condition is typically slow, the lack of
response to treatment and the advancement of
the disease continues to be significant
challenges in medical practice [2]. The
proliferative growth of deviant monoclonal B
lymphocytes distinguishes CLL as a malignant
B cell neoplasm. CLL constitutes 25% of all
cases of leukemia in Western nations, making
it the most prevalent subtype. While a
considerable number of patients do not
manifest any symptoms, a subset may display
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characteristic symptoms of lymphoma,
acquired immunodeficiency disorders, or
autoimmune complications [3]. On a global
scale, the prevalence of CLL has been steadily
rising. There was a small decrease in the
number of deaths and disability-adjusted life
years (DALYs). The socio-demographic index
(SDI) influences the impact of mortality and
DALY. With advancing age, there is a notable
increase in the incidence rate, death rate, and
DALY rate of CLL. Males and females had
different incidence rates across different SDI
quintiles. Researchers identified smoking,
elevated body mass index, and workplace
exposure to benzene or formaldehyde as
potential risk factors associated with CLL.
Global age-standardized incidence rates
(ASIRs) are projected to rise until 2030,
whereas ASRs are expected to decline until
2030 [4].
CLL is a form of adult leukemia characterized
by the clonal accumulation of lymphocytes.
Immunophenotypic changes have proven to
be highly valuable in predicting the clinical
course, patient survival, and guiding initial
treatment decisions [5].
CLL in Sudan is a disease commonly found in
older individuals, as described in the
literature, with a higher prevalence among
males compared to females. Overall, different
age and sex groups showed consistent
distribution of hematological parameters. A
significant number of patients experienced
vague symptoms, and a considerable portion
of them sought medical attention at advanced
stages, which is a common trend in many
developing nations [6]. Thus, the current study
seeks to evaluate if there are variations in
blood parameters between CLL and other
subtypes of leukemia.
MATERIALS AND METHODS
The current study utilized lymphoma data
acquired from El-Obeid Oncology Center. The
document included data on lymphoma
patients diagnosed between January 2018 and
January 2020. The sample included a total of
one hundred patients, of which sixty-one had
CLL and forty-nine did not. We have diagnosed
the patient with lymphoma based on
traditional BM aspiration. We conducted a
reassessment of the diagnosis of the blood
samples to confirm the previous diagnosis and
categorize the lymphomas into CLL and non-
CLL types. We performed further tests, such as
flow cytometry and molecular analyses, on a
subset of individuals. We also conducted a
blood analysis to assess various parameters.
The obtained information sets were entered
into a computer program called Statistical
Package for Social Sciences (SPSS version 16;
SPSS Inc., Chicago, IL). The chi-square test was
used, and P < 0.05 was considered significant.
Ethical Considerations
The protocol of this study was established in
accordance with the 2013 Declaration of
Helsinki, and this study was further approved
by Human Research Ethical Committee at
MRCC: HREC 0006/MRCC.3/24.
Statistical Analysis
The Statistical Package for the Social Sciences
(SPSS) version 24 was used for the statistical
analyses. Descriptive data reported as
frequencies and percentages were included in
the statistical analysis.
RESULTS
This study investigated 100 patients aged 15
to 117 years, with a mean age of 61. Of the 100
patients, 57 were men and 43 were women.
For this group of people, CLL was the most
common type of cancer. It was followed by
Chronic Myeloid Leukemia (CML), Non-
Hodgkin's lymphoma (NHL), Multiple
Myeloma (MM), Hodgkin's lymphoma (HL),
and other types, which made up 61%, 17%,
11%, 6%, and 3%, respectively.
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Figure 1. Proportions of leukemia subtypes.
Table 1 describes the distribution of leukemia types based on bone marrow (BM) cellular alterations.
All cases of CLL, MM, and NHL showed BM hypercellularity.
Megakaryopoiesis was not found in ten cases, including eight (80%) CLL patients and two (20%) MM
patients. Megakaryopoiesis was observed in 43 cases, including 26/43 (60.5%) CLL cases and 13/43
(30.2%) CML cases. Only two cases of CLL had depressed megakaryopoiesis.
34 patients, including 20/34 (59%) CLL, 9/34 (26.5%) CML, and 3/34 (8.8%) MM, had depressed
erythropoiesis.
We found depressed granulopoiesis in 9 patients, 7 of whom (77.8%) had CLL. We detected myeloid
cells in 16 individuals, of which 14 (87.5%) had CML.
Table 1. Distribution of leukemia types according to bone marrow (BM) cellular changes
Variable
CLL
HL
NHL
MM
CML
Other
Total
BM Cellurality
Hyper
40
1
3
4
16
1
65
Normal
0
0
0
1
0
0
1
Total
40
1
3
5
16
1
66
Megakaryopoiesis
Not seen
8
0
0
2
0
0
10
Seen
26
0
2
1
13
1
43
Normal
2
0
0
0
1
0
3
Active
2
1
1
1
2
0
7
Depressed
2
0
0
0
0
0
2
Total
40
1
3
4
16
1
65
Erythropoiesis
Normal
19
0
1
1
7
0
28
61%17%
11%
6% 3%2%
CLL CML NHL MM HL Others
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Depressed
20
0
1
3
9
1
34
Active
1
1
1
0
0
0
3
Total
40
1
3
4
16
1
65
Granulopoiesis
Normal
30
0
2
1
1
0
34
Depressed
7
0
0
1
0
1
9
Active
0
1
0
1
1
0
3
Myeloid cells
1
0
1
0
14
0
16
Plasma cell
0
0
0
2
0
0
2
Total
38
1
3
5
16
1
64
Table 2 and Figure 2 summarized the
distribution of leukemia types as
hematological parameters changed. CLL cases
had the lowest Hb concentration, followed by
CML and NHL at 46/80 (57.5%), 17/80
(21.3%), and 11/80 (13.8%), respectively.
We found low MCHC in 16 patients, of which
10 (62.5%) had CLL and 3 (18.8%) had CML.
CLLs were the only two patients with a high
MCHC.
CLL, CML, and NHL showed the lowest MCH,
with 15/33 (45.5%), 7/33 (21.2%), and 5/33
(15.2%), respectively.
CLL had the lowest hematocrit, followed by
CML and NHL, with values of 30/60 (50%),
17/60 (28.3%), and 7/60 (11.7%),
respectively.
48 patients, including 23/48 (48%) with CLL
and 14/48 (29%) with CML, had low TRBCs.
31 patients, 26 of whom (83.9%) had CLL, had
low platelet counts. On the other hand,
elevated platelet counts were detected in ten
individuals, seven of whom (70%) had CML.
However, when the percentages of all
leukemia subtypes were calculated, significant
variations were discovered.
Table 2. Distribution of the leukemia types by hematological parameter changes
Variable
CLL
HL
NHL
MM
CML
Other
Total
Hb-Concentration
Low
46
1
11
5
17
0
80
Normal
7
2
0
0
0
1
10
High
1
0
0
0
0
0
1
Total
54
3
11
5
17
1
91
Mean corpuscular hemoglobin concentration (MCHC)
Low
10
0
2
1
3
16
Normal
27
3
7
4
10
51
High
2
0
0
0
4
6
Total
39
3
9
5
17
73
Mean corpuscular hemoglobin (MCH)
Low
15
3
5
3
7
33
Normal
22
0
4
1
6
33
High
3
0
0
1
4
8
Total
40
3
9
5
17
74
Hematocrit
Low
30
1
7
5
17
60
Normal
10
2
2
0
0
14
Total
40
3
9
5
17
74
Total Red blood cells count (TRBCs)
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Low
23
1
7
3
14
48
Normal
16
2
3
2
2
25
High
1
0
0
0
0
1
Total
40
3
10
5
16
74
Total Platelets count
Low
26
0
3
2
0
0
31
Normal
26
2
7
2
10
1
48
High
0
1
1
1
7
0
10
Total
52
3
11
5
17
1
89
Figure 2. Description of the proportions of the hematological parameters within the entire
leukemia type.
Table 3 and Figure 3 describe the changes in
the distribution of leukemia types based on
white blood cells. A high WBC count was found
in 74 patients, 53 (71.6%) of whom had CLL
and 17 (23%) had CML. There were only four
cases with low total WBC counts, three of
which (75%) were MM.
63 patients, 51 (81%) with CLL and 8 (12.7%)
with NHL, had a high lymphocyte count. There
were 15 cases of low lymphocyte count, of
which 13 (86.7%) were CML.
The lowest neutrophil cell count was recorded
in CLL, followed by NHL, with 37/50 (74%)
and 8/50 (16%), respectively. We detected
only four cases of CML with a high neutrophil
level. Of the nine cases with low monocyte cell
counts, seven (77.8%) were CLL. High
monocyte counts were found in five patients,
three of whom (60%) had CLL.
88%
11%
1%
22%
70%
8%
45% 45%
10%
81%
19%
65%
34%
1%
35%
54%
11%
0%
20%
40%
60%
80%
100%
120%
CLL CML Total HL NHL MM
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Table 3. Distribution of the leukemia types by white blood cell changes
Variable
CLL
HL
NHL
MM
CML
Other
Total
Total white blood cells count (WBCs)
Low
0
1
0
3
0
0
4
Normal
2
1
8
2
0
1
14
High
53
1
3
0
17
0
74
Total
55
3
11
5
17
1
92
Lymphocyte cells count
Low
1
0
0
1
13
15
Normal
1
0
2
3
4
10
High
51
3
8
1
0
63
Total
53
3
10
5
17
88
Neutrophil cells Count
Low
37
3
8
2
0
50
Normal
5
0
1
3
13
22
High
0
0
0
0
4
4
Total
42
3
9
5
17
76
Monocyte Cells Count
Low
7
0
0
0
2
9
Normal
29
2
7
3
12
53
High
3
0
0
1
1
5
Total
39
2
7
4
15
67
CLL
NHL
CML
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
4%
15%
81%
17% 11%
72% 66%
29%
5% 13%
79%
8%
CLL HL NHL MM CML Total
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Figure 3. Description of the proportions of the white blood cells changes within entire
leukemia type.
DISCUSSION
The investigation of hematological parameters
in various types of leukemia can provide
insights into distinct cancer types and serve as
a predictor for CLL progression behaviors.
Consequentially, this study aimed to conduct a
comparative analysis of the hematological
characteristics of CLL with other kinds of
leukemia. The results of the present
investigation indicate that males are more
commonly afflicted with leukemias than
females. Men tend to have higher rates of
incidence and mortality than women,
according to previous reports. This
emphasizes the importance of considering
biological and epidemiological factors in
understanding the impact of the disease [7, 8]
(Li et al., 2020; Rifat et al., 2023). Previous
studies have revealed considerable
inequalities between sexes in a variety of
domains, including awareness, treatment,
healthcare utilization, disease control rate,
time to diagnosis, occupational exposure, and
overall survival rates [9, 10]. Abera Abaerei et
al. (2017); Amini et al. (2023).
The current investigation found a substantial
increase in BM hypercellularity in all cases of
CLL, MM, and NHL. Enhancing stimulation to
generate more of a single cell line can lead to
an increase in the production of other cell
lines, resulting in an overall increase in bone
marrow cellularity. Bone marrow cellularity
changes can influence individual cell lines or
the cells as a whole [11]( Weiss, 2010).
This study observed megakaryopoiesis in
60.5% of CLL cases and 30.2% of CML cases.
We found that two CLL patients reported cases
of depressed megakaryopoiesis. There was a
discovery of decreased erythropoiesis in 59%
of CLL cases, 26.5% of CML cases, and 8.8% of
MM cases. Out of the nine patients, a
significant majority (77.8%) displayed
depressed granulopoiesis. Interestingly, seven
of these patients also happened to have CLL.
Observations revealed that 14 of the 16
individuals with myeloid cells, accounting for
87.5%, received a diagnosis of CML. Recent
research highlights the bone marrow niche as
a crucial factor in the development of
hematopoietic stem cells, revealing intriguing
and intricate environmental influences.
Megakaryocytes adhere to the complex bone
marrow microenvironment, which includes
interactions between cells, contact with the
extracellular matrix, and blood circulation
within the sinusoidal lumen. Mutations in both
germinal and acquired hematopoietic stem
cells can alter the maturation, proliferation,
and platelet output of megakaryocytes.
Disrupted megakaryopoiesis can also impact
the hematopoietic niche, highlighting the
significant role of megakaryocytes in
maintaining bone marrow balance [12]( Di
Buduo et al., 2023).
This study found a strong link between two
types of leukemiachronic lymphocytic
leukemia (CLL) and chronic myeloid leukemia
(CML)and red blood cells (RBCs), mean
corpuscular hemoglobin concentration
(MCHC), and mean corpuscular hemoglobin
(MCH).
Velez et al.'s 2014 study revealed that people
with CLL are more likely than the general
population to develop a second malignancy,
specifically skin cancer [13]. CLL is also
associated with a greater incidence of second
hematological malignancies, as demonstrated
by Hatoum et al. in 2007 [14]. Usually, this
process involves transforming a disease into a
more potent variant of non-Hodgkin
lymphoma, multiple myeloma, or
prolymphocytic lymphoma. CLL patients have
a relatively low chance of developing AML. In
addition, individuals with myeloproliferative
disorders are more likely to develop lymphoid
malignancies [15]. (Frederiksen et al., 2011).
These findings suggest that myeloid
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malignancies can transform into lymphoid
malignancies and vice versa. Giri et al.
reported the common detection of AML after
CLL treatment in 2015 [16].
71.6% of patients with CLL had a significant
increase in white blood cell count (WBC
elevation > 100 x 10(9)/L), while 23% of
patients had CML. While the impact of an
increased WBC count on survival is evident
during the initial diagnosis of CLL, its
significance in the later stages of the disease is
still uncertain.[17]( Silverman et al., 2002).
The current study observed a high lymphocyte
count in CLL and a low lymphocyte count in
CML. Diagnosed CLL requires a peripheral
blood absolute lymphocyte count (ALC) of 5 x
10(9)/l or higher. Consistent relative
lymphocytosis of > or = 50% of the differential
leukocyte count in older adults (50+) suggests
CLL inquiry by immunophenotyping
peripheral blood lymphocytes and bone
marrow [18]( Angelillo et al. 2018). CML is
considered to be one of the best-known types
of myeloproliferative neoplasms. It usually
presents with an increase in white blood cell
count, but only rarely with an isolated increase
in platelet count or lymphocytes [19](
Findakly and Arslan, 2020).
Hematopoietic stem cells (HSCs) play a crucial
role in the production of all blood cells through
their remarkable proliferative abilities. The
durability and impressive capacity for self-
renewal of HSCs nevertheless render them
prone to the accumulation of mutations.
Acquired mutations commonly cause
preleukemic clonal hematopoiesis in older
individuals. While often showing no
symptoms, the preleukemic state increases
the vulnerability to blood malignancies.
However, while preleukemic HSCs play a
widely recognized role in adult myeloid
leukemia (AML), their influence on other
hematopoietic malignancies has received less
extensive research [20]. According to Filipek-
looking into pre-clinical chronic myeloid
leukemia (CML) has grown significantly. This
is a condition that happens before the chronic
phase (CP) and doesn't have leukocytosis or
other blood/marrow features of CML CP [21]
(Kuan et al. 2018). This variation may explain
the different results observed in the current
investigation's blood parameter counts.
Although the present study presents
important updates about leukemia from
Sudan, it has some limitations, including the
outnumber of CLL compared to other types of
leukemia in this study. This reduces the
comparability level.
In conclusion, CLL exhibits a distinct pattern
of hematological parameters in comparison to
other blood malignancies. CML exhibits a
pattern that's comparable to CLL in various
hematological parameters, including the total
count of white blood cells. Additional research
in this context is considered crucial for
revealing the precise connection between CLL
and other blood malignancies, which
highlights the alterations in the peripheral
blood image.
FUNDING:
Funded by Prof Medical Research Center- MRCC.
DATA AVAILABILITY:
The data presented in this study are available on
request to the corresponding author.
DISCLOSURE OF INTEREST
No interest to declare
REFERENCES
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