Abstract
Background/Objectives: Chronic lymphocytic leukemia (CLL) displays substantial clinical heterogeneity, yet access to genomic prognostic testing remains limited in many real-world and resource-constrained settings. Readily available biomarkers that reflect disease biology are therefore clinically valuable. Serum albumin, an inexpensive marker associated with systemic inflammation and tumor burden, has shown emerging prognostic potential. This study evaluated the impact of baseline albumin on time to first treatment (TTFT) and overall survival (OS) in CLL. Methods: We retrospectively analyzed adult patients with confirmed CLL treated at a single tertiary center. Baseline demographic, clinical, and laboratory features were recorded, and serum albumin was dichotomized at 4 g/dL. TTFT and OS were estimated using the Kaplan–Meier methodology. Variables with p < 0.1 in univariate analyses were included in multivariate Cox regression models. Results: A total of 230 patients were included. The median age at diagnosis was 62.5 years; 52.2% were male, and 14.8% had serum albumin <4 g/dL. Low albumin was associated with older age, advanced Rai/Binet stage, anemia, higher lymphocyte counts, and greater treatment requirement (all p < 0.05). Median follow-up was 20 months (range, 1–288). Patients with albumin <4 g/dL had inferior 5-year OS (78.4% vs. 98.7%). Although serum albumin correlated with both TTFT and OS in univariate analyses, it did not remain independently significant in multivariate models. Conclusions: While not independently prognostic, baseline serum albumin is strongly linked to adverse clinical features and poorer unadjusted survival. As a readily available, low-cost parameter, albumin may offer practical value for early risk stratification—particularly in regions where routine molecular testing is constrained.