Autoimmune cytopenia in chronic lymphocytic leukemia: prevalence, clinical associations, and prognostic significance

Abstract

We analyzed prevalence, characteristics, clinical correlates, and prognostic significance of autoimmune cytopenia in patients with chronic lymphocytic leukemia. Seventy of 960 unselected patients (7%) had autoimmune cytopenia, of whom 19 were detected at diagnosis, 3 before diagnosis, and 48 during the course of the disease. Forty-nine patients had autoimmune hemolytic anemia, 20 had immune thrombocytopenic purpura, and 1 had both conditions. A clear association was observed between autoimmune cytopenia and poor prognostic variables (ie, high blood lymphocyte count, rapid blood lymphocyte doubling time, increased serum ␤-2 microglobulin level, and high expression of -associated protein 70 and CD38). Nevertheless, the outcome of patients with autoimmune cytopenia as a whole was not significantly different from that of patients without this complication. Furthermore, no differences were observed according to time at which cytopenia was detected (ie, at diagnosis, during course of disease). Importantly, patients with advanced (Binet stage C) disease because of an autoimmune mechanism had a significantly better survival than patients in advanced stage related to a massive bone marrow infiltration (median survivals: 7.4 years vs 3.7 years; P ‫؍‬ .02). These results emphasize the importance of determining the origin of cytopenia in patients with chronic lymphocytic leukemia for both treatment and prognostic purposes. (Blood. 2010; 116(23):4771-4776)

Characteristics and outcome of warm autoimmune hemolytic anemia in adults: New insights based on a single‐center experience with 60 patients

“…We confirm in this series, as previously reported, that lymphoproliferative disorders are frequently associated with wAIHA and that wAIHA may precede by months or even years the onset of lymphoma. Chronic lymphocytic leukemia (CLL), classically the leading cause of secondary AIHA [18], represented only 3/14 cases of lymphoproliferative disorders in the present series, and 4/15 cases in the previous series [5]. This low rate is probably explained by AIHA occurring mainly in patients with active CLL who are usually followed in Departments of hemato-oncology.…”

Direct Coombs Test Positivity in B-Chronic Lymphoid Leukemia: a Marker of Advanced Clinical Disease

“…Various studies conducted in United State, Israel, Spain, England and Rome have reported a frequency of positive DAT in 4.5%, 7%, 4.3%, 7.7% and 3.7% of CLL patients respectively (Kyasa et al, 2003;Lischner et al, l988;Moreno et al, 2010;Hamblin et al, 1986;Mauro et al, 2000). However the prevalence of DAT positivity in our patients appears to be higher than these studies conducted in western world.…”

“…This highlights the importance of determining the origin of the cytopenia in CLL patients for both prognostic and therapeutic reasons (Clive et al, 2010;Moreno et al, 2010).…”

“…Literature review illustrated that between 3% to as high as 37% of patients with CLL develop AIHA during the course of illness (Moreno et al, 2010).…”

Bendamustine and rituximab combination in the management of chronic lymphocytic leukemia‐associated autoimmune hemolytic anemia: A multicentric retrospective study of the French CLL intergroup (GCFLLC/MW and GOELAMS)

“…Autoimmune hemolytic anemia (AIHA) is a well-known complication of chronic lymphocytic leukemia (CLL), occurring in about 5-15% of the patients during the course of the disease [1,2]. There is no evidence-based strategy for the treatment of AIHA associated to CLL, especially in relapsed or resistant AIHA or when AIHA is associated with progressive CLL, because these patients are generally excluded from clinical trials.…”