Pure Nodal Small Lymphocytic Lymphoma: Clinical, Pathologic, and Outcome Features in a Single-Center Cohort.

Background and Objectives: Small lymphocytic lymphoma (SLL) represents the tissue-based manifestation of chronic lymphocytic leukemia (CLL). Despite their shared biological background, patients with SLL have been underrepresented in CLL-focused clinical trials, and data addressing the clinical behavior of pure nodal SLL remain scarce. The present study aimed to identify factors associated with time to first treatment (TTFT) and progression-only survival in patients with pure nodal SLL. Materials and Methods: In this prospective observational study, 46 patients with pure nodal SLL were included and followed for a median duration of approximately 5 years. Clinical, laboratory, histopathological, and TP53-related parameters were evaluated for their prognostic impact on TTFT and progression-only survival. Results: On univariable analysis, advanced-stage disease, hemoglobin < 10 g/dL, elevated serum β2M, elevated lactate dehydrogenase, del(17p), and aberrant p53 immunohistochemical expression were significantly associated with shorter TTFT and progression-only survival. Conclusions: Pure nodal SLL is a heterogeneous entity with a variable clinical course. Easily assessable clinical and biological parameters, including TP53 abnormalities, may help predict treatment requirement and disease progression, thereby contributing to better risk stratification and more individualized management. Kaplan-Meier analysis demonstrated significantly shorter time-to-first-treatment (TTFT) among patients with elevated β2M levels (≥3.5 mg/L), bulky lymphadenopathy (≥5 cm), and advanced-stage disease.