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. 2025;29(1):28-35.
doi: 10.5114/wo.2025.149235. Epub 2025 Apr 9.

Accelerated chronic lymphocytic leukemia - characteristics and retrospective analysis of the Polish Adult Leukemia Study Group

Oktawia Sośnia  1 , Elżbieta Iskierka-Jażdżewska  2   3 , Anna Puła  2   4   5 , Kamil Wiśniewski  1 , Joanna Drozd-Sokołowska  6 , Marta Morawska  7 , Urszula Gosik  7 , Dariusz Woszczyk  8 , Agata Ogłoza  9 , Kamil Wdowiak  10 , Ewa Paszkiewicz-Kozik  11 , Ewa Wąsik-Szczepanek  12 , Mirosław Markiewicz  13 , Magdalena Zawartko  14 , Anna Kokoć  12 , Anna Szumera-Ciećkiewicz  15   16 , Monika Prochorec-Sobieszek  17 , Dorota Jesionek-Kupnicka  18 , Marcin Braun  18 , Beata Gierej  19 , Tadeusz Robak  2   3 , Ewa Lech-Marańda  1 , Bartosz Puła  1   2
Affiliations

Accelerated chronic lymphocytic leukemia - characteristics and retrospective analysis of the Polish Adult Leukemia Study Group

Oktawia Sośnia et al. Contemp Oncol (Pozn). 2025.

Abstract

Introduction: Accelerated chronic lymphocytic leukemia (A-CLL) is a rare histological variant of CLL, which is associated with an aggressive clinical presentation and worse prognosis. The aim was to study the characteristics and treatment outcomes of A-CLL patients.

Material and methods: The retrospective analysis included 106 A-CLL patients treated in Poland between 2013 and 2023.

Results: Median overall survival (OS) for treatment-naive A-CLL was 6.05 years (95% CI: 4.7-NA) and median progression-free survival (PFS) was 5.66 years (95% CI: 4.05-6.34). Factors associated with worse PFS were: Eastern Cooperative Oncology Group > 2 (p < 0.0001) and del17p (p = 0.002). In the whole group, fludarabine-based regimens improved OS (p = 0.002) and PFS (p = 0.002). This therapy proved superior to R-CHOP-like protocols for both OS (p = 0.002) and PFS (p = 0.004). The difference in survival between fludarabine-based regimens and targeted therapy was not significant. However, the group of patients treated with new therapies was very heterogeneous. Fludarabine (p = 0.004) or targeted therapy (p = 0.02) in any line of treatment during acceleration was associated with a reduced risk of death.

Conclusions: This study represents one of the largest datasets of A-CLL patients and shows its poorer prognosis compared to typical CLL. Chronic lymphocytic leukemia directed therapy should be considered as a treatment modality of choice for A-CLL. R-CHOP protocols are less effective.

Keywords: Richter transformation; acceleration; chronic lymphocytic leukemia.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Kaplan-Meier survival curves for overall survival for treatment-naive (TN) accelerated chronic lymphocytic leukemia (A-CLL) patients (A) and relapsed/refractory (RR) A-CLL patients (B), progression-free survival for TN A-CLL patients (C) and RR A- CLL patients (D) OS – overall survival, PFS – progression-free survival
Fig. 2
Fig. 2
Overall survival (A) and progression-free survival (B) in treatment-naive accelerated chronic lymphocytic leukemia patients treated with fludarabine vs other treatment regimens OS – overall survival, PFS – progression-free survival
Figure 3
Figure 3
Overall survival (OS; A) and progression-free survival (PFS; B) in RR A-CLL patients treated with targeted therapy vs other treatment regimens OS – overall survival, PFS – progression-free surviva
Fig. 4
Fig. 4
Time to diagnosis of accelerated chronic lymphocytic leukemia in regard to previous treatment (A) and patient age (B)
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