Real-world data of lebanese patients with chronic lymphocytic leukemia.

e19512 Background: Many advances in the treatment of chronic lymphocytic leukemia (CLL) has been made in the 6 past years aiming at attaining durable complete responses and even cure. The choice of upfront therapy is driven by several factors including presence of 17p deletion or TP53 mutation, IGHV mutation status, patient fitness, comorbidities, drug availability and affordability etc.. The aim of the current study was to describe aspects of CLL in real world data setting in Lebanon regarding patients’ characteristics, diagnostic studies, indications for therapy and implication of new treatments including small molecule inhibitors including Bruton Tyrosine Kinase BTK and BCL2 inhibitors. Methods: This was an observational prospective study (2004-2021) of consecutively diagnosed patients with CLL at a single center in Lebanon. The characteristics, indication for treatment, types of treatment used were recorded progression free survival (PFS) was defined as the time from treatment initiation at first line until progression from any cause. Results: The registry covered 128 patients, 82 males and 46 females (ratio 1.78:1). Median age at diagnosis was 66 years. 23.6% were younger than 55 years. 73% of patients were asymptomatic at diagnosis, and 25% had lymphadenopathies. RAI stage 0 (BINET stage A) was observed in 73%. Median absolute lymphocytic count was 15,340 (unit), median hemoglobin was13.2. and median platelet count was 188,000. FISH panel was done in 56 patients (43%) and IGHV in 13%. 17p deletion was detected in 14.3%, and 13q deletion as a sole abnormality in 46.6%. 15.7% of patients required treatment at diagnosis; 52.6 % of them due to anemia/thrombocytopenia, and 15.8% due to presence of constitutional symptoms; other treatment indications included massive splenomegaly, and massive or symptomatic lymphadenopathy. 71 patients (55.4%) fell into the watch and wait category; 37 of which required treatment at some point during follow up with a median duration from diagnosis till starting treatment of 34 months.FCR Fludarabine + cyclophosphamide + rituximab (38.5%), BR bendamustine + Rituximab (23%), and Ibrutinib (19.2%) were the most common regimens used upfront. PFS was not reached. and correlation between genetic features and survival couldn’t be done, due to the relatively small number of patients whom showed progression. Conclusions: Epidemiologic characteristics of Lebanese patients with CLL is comparable to the international data.Molecular studies are being more implicated in the diagnostic workup. FCR and BR were mostly used upfront during the previous decade. We noticed a trend toward using Ibrutinib after 2016 in frontline and relapsed setting (after its approval and availability).