Chronic lymphocytic leukemia and the skin: implications for the dermatologist

Abstract

B-cell chronic lymphocytic leukemia (CLL) is the most prevalent leukemia in the United States, and its diagnosis can have many dermatologic implications. For one, the cutaneous manifestations of CLL include several entities, most notably leukemia cutis, eosinophilic dermatosis of hematologic malignancy, and a heightened risk of skin infections.Additionally, CLL patients are at an increased risk of secondary malignancies, most commonly of the skin. Furthermore, a number of commonly utilized treatments for CLL have cutaneous implications which should be considered in the interdisciplinary management of CLL patients. In this review, we will provide an update on the diverse cutaneous manifestations of CLL and CLL-directed therapies in order to help guide dermatologic management of this increasingly prevalent patient population. Key points• B-cell chronic lymphocytic leukemia is the most prevalent leukemia in the United States and has many associated dermatologic implications.• Dermatologists should consider primary leukemic infiltration, increased incidence and severity of secondary cutaneous malignancies, and the cutaneous manifestations of commonly utilized treatments when managing this patient population. Diagnosis of oncohematologic diseaseRecurrent episodes of pruritic papules, nodules, urticarial plaques, or vesiculobullous eruptions, refractory to standard treatment Eosinophilic infiltrate on histopathology Exclusion of other causes of tissue eosinophilia

The diverse landscape of dermatologic toxicities of non‐immune checkpoint inhibitor monoclonal antibody‐based cancer therapy

“…CD20 is also the target for the glycoengineered (afucosylated) type II anti‐CD20 mAb obinutuzumab, which increases Fcγ receptor IIIa immune‐surface binding and facilitates greater antibody‐dependent and cell‐mediated cytotoxicity, neutrophil activation, and B‐cell depletion during CLL treatment than does rituximab 212,305 . Oral and cutaneous lichenoid, psoriasiform, and sweet‐like cAE have been reported with obinutuzumab exposure 132,133 …”

“…212,305 Oral and cutaneous lichenoid, psoriasiform, and sweet-like cAE have been reported with obinutuzumab exposure. 132,133 Mosunetuzumab is a heterodimeric bispecific antibody with binding sites for CD20 and CD3 that activates and redirects T-cells to target malignant B-cells. 303 The most commonly reported adverse event is cytokine release syndrome, which can present as a generalized cAE among many other symptoms.…”

Leukemia Cutis As the Initial Manifestation of Chronic Lymphocytic Leukemia Progression

“…The cutaneous manifestations of CLL may be classified as specific if they are caused by direct seeding of B-cells or as nonspecific if they are secondary to the increased risk posed by CLL to develop skin lesions. For instance, Leukemia Cutis and Richter's syndrome are specific CLL cutaneous manifestations while Sweet's syndrome, urticaria, and exfoliative erythroderma are nonspecific manifestations [6].…”

Dermatological manifestations of hematologic neoplasms. Part I: secondary specific skin lesions

“…Considering the different types of leukemias, a prevalence of LC of 10% to 15% is observed in AML, 2 , 3 , 8 , 9 of which the myelomonocytic (AMML) and monocytic (MoAL) subtypes are the most affected, in up to half of the cases. 2 , 5 , 6 In CLL, the most common presentation of systemic leukemias, LC is reported in 4% to 27% of these cases, 3 , 15 , 16 more frequently in the Richter’s syndrome, which is the rare transformation of CLL into a large cell lymphoma. 15 Regarding the other types of leukemia, data show the involvement of 1% to 3% in ALL and 2% in CML.…”

“… 2 , 5 , 6 In CLL, the most common presentation of systemic leukemias, LC is reported in 4% to 27% of these cases, 3 , 15 , 16 more frequently in the Richter’s syndrome, which is the rare transformation of CLL into a large cell lymphoma. 15 Regarding the other types of leukemia, data show the involvement of 1% to 3% in ALL and 2% in CML. 9 …”