alexa Symptoms of adult chronic and acute leukaemia before diagnosis: large primary care case-control studies using electronic records.


Journal of Blood Disorders & Transfusion

Author(s): Shephard EA, Neal RD, Rose PW, Walter FM, Hamilton W

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Abstract BACKGROUND: Leukaemia is the eleventh commonest UK cancer. The four main subtypes have different clinical profiles, particularly between chronic and acute types. AIM: To identify the symptom profiles of chronic and acute leukaemia in adults in primary care. DESIGN AND SETTING: Matched case-control studies using Clinical Practice Research Datalink records. METHOD: Putative symptoms of leukaemia were identified in the year before diagnosis. Conditional logistic regression was used for analysis, and positive predictive values (PPVs) were calculated to estimate risk. RESULTS: Of cases diagnosed between 2000 and 2009, 4655 were aged ≥40 years (2877 chronic leukaemia (CL), 937 acute leukaemia (AL), 841 unreported subtype). Ten symptoms were independently associated with CL, the three strongest being: lymphadenopathy (odds ratio [OR] 22, 95\% confidence interval [CI] = 13 to 36), weight loss (OR 3.0, 95\% CI = 2.1 to 4.2), and bruising (OR 2.3, 95\% CI = 1.6 to 3.2). Thirteen symptoms were independently associated with AL, the three strongest being: nosebleeds and/or bleeding gums (OR 5.7, 95\% CI = 3.1 to 10), fever (OR 5.3, 95\% CI = 2.7 to 10), and fatigue (OR 4.4, 95\% CI = 3.3 to 6.0). No individual symptom or combination of symptoms had a PPV >1\%. CONCLUSION: The symptom profiles of CL and AL have both overlapping and distinct features. This presents a dichotomy for GPs: diagnosis, by performing a full blood count, is easy; however, the symptoms of leukaemia are non-specific and of relatively low risk. This explains why many leukaemia diagnoses are unexpected findings. © British Journal of General Practice 2016.
This article was published in Br J Gen Pract and referenced in Journal of Blood Disorders & Transfusion

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