Real-World Care Gaps and Survival Outcomes in Chronic Lymphocytic Leukaemia: A 20-Year Retrospective Study from Nigeria

Abstract

Background: Chronic lymphocytic leukaemia (CLL) outcomes in low-resource settings are shaped not only by disease biology, but also by delayed diagnosis, limited access to therapeutic options, and treatment interruptions due to social and financial reasons. However, data describing these real-world care gaps in sub-Saharan Africa remain limited. We aimed at evaluating the pattern of presentation, treatment access, and outcomes in CLL patients at a tertiary hospital in Nigeria. Methods: This was a twenty-year retrospective study of patients diagnosed with CLL at the university of Port Harcourt teaching hospital.The demographic, clinical, laboratory, treatment, outcome and source of funding records were extracted from the patients’ folders. Data was analyzed using SPSS® version 26. Overall survival (OS) was estimated using the Kaplan–Meier method, with censoring at last contact for patients alive or lost to follow-up. Results: A total of 46 patients were included in the study. Median age at diagnosis was 53 years (IQR 49.3 – 61.5), and females were slightly more affected (n=24; 52.2%), giving a male-to-female ratio of 1:1.1. The median WBC was 81.9 ×10⁹/L (IQR: 53.6 – 121.0 ×10⁹/L), anaemia was common (n=30, 65.2%), with 9 patients (19.6%) having severe anaemia while 11 cases (23.9%) had thrombocytopenia. Staging showed 35 (76.1%) presented in Rai stage III–IV and 25 (54.3%) in Binet stage C. Overall, 38 (82.6%) received treatment, the most commonly prescribed regimens were CP (n=13, 28.3%) and CyP (n=7, 15.2%). Only 6 patients (13.0%) received a rituximab-based regimen. The overall response rate was 50%. Majority, n= 43 (93.5%) financed their treatment out-of-pocket. At last contact, 22 (47.8%) patients had died, 20 (43.5%) were lost to follow-up, while 3/46 (6.5%) were alive. The median observed OS was 16.0 months. Treated patients had a significantly longer median OS than untreated patients (17.0 vs 2.5 months; log-rank p < 0.001). Conclusions: This study highlights substantial real-world care gaps in CLL management   in our environment. Patients commonly presented at late stage and had limited access to optimal therapy with poor outcomes.  These findings highlight the need for earlier diagnosis, improved treatment affordability, and stronger continuity of care in resource-constrained settings.