Impact of immune thrombocytopenia on the clinical course of chronic lymphocytic leukemia

Abstract

The prevalence, clinical characteristics, and prognostic significance of immune thrombocytopenia (IT) in patients with chronic lymphocytic leukemia (CLL) have not been clearly determined. To clarify this, we retrospectively analyzed 1278 consecutive newly diagnosed patients with CLL. Criteria for IT diagnosis included the following: rapid (< 2 weeks) and severe fall (half of the initial level and below 100 ؋ 10 9 /L) in platelet count; normal or augmented megakaryocytes in bone marrow; no or limited (not palpable) splenomegaly; no cytotoxic treatment in the preceding month. Sixty-four patients (5%) were diagnosed with IT. The median time to IT from CLL diagnosis was 13 months (range, 0-81 months), and median platelet count at IT diagnosis was 14 ؋ 10 9 /L (range, 1-71 ؋ 10 9 /L). Fifty-six of the 64 patients (87%) received treatment for IT. The probability of responding to treatment for IT was significantly higher for patients receiving chemotherapy with or without steroids than for patients treated with intravenous immunoglobulins with or without steroids (P ‫؍‬ .01). The development of IT was significantly associated with unmutated IgVh, a positive direct antiglobulin test, and the occurrence of autoimmune hemolytic anemia. Patients with CLL and IT had poorer survival than other patients with CLL (5-year overall survival 64% vs 82%, P < .001), and this effect was independent from common clinical prognostic variables.

The impact of baseline and interim PET/CT parameters on clinical outcome in patients with diffuse large B cell lymphoma

“…Instead, absolute value of SUV sum letters American Journal of Hematology 937 from baseline PET/CT, and SUV max and SUV sum from interim PET/CT were significantly relevant to PFS in all patients, and in patients with an IPI score of 1-3. The international prognostic index (IPI) has been the most powerful predictor of outcome in patients with aggressive non-Hodgkin's lymphoma (NHL) since 1990s [1]. However, with the introduction of novel treatment with superior effectiveness, the significance of this prognostic system had to be re-evaluated.…”

“…The international prognostic index (IPI) has been the most powerful predictor of outcome in patients with aggressive non-Hodgkin's lymphoma (NHL) since 1990s [1]. However, with the introduction of novel treatment with superior effectiveness, the significance of this prognostic system had to be re-evaluated.…”

Disease-Specific Complications of Chronic Lymphocytic Leukemia

“…A recent Italian review identified 5% of ITP cases in a series of 1278 newly diagnosed CLL patients. 39 The median time from CLL diagnosis to diagnosis of ITP was 13 months and the median platelet count was 14 × 10 9 /L. The development of ITP occurred predominantly in patients who were not receiving therapy, 25% of the cases occurring at, or shortly after, CLL diagnosis.…”

B‐cell receptor configuration and adverse cytogenetics are associated with autoimmune hemolytic anemia in chronic lymphocytic leukemia

“…Following previously reported criteria [14,15], the diagnosis of AIHA required the presence of all the following criteria, provided no other identified cause of anemia: (i) Hb levels lower than or equal to 110 g/L in the absence of any cytotoxic treatment in the preceding month; (ii) one or more laboratory signs of hemolysis (increased bilirubin, elevated lactic dehydrogenase, and reduced haptoglobin); and (iii) positive direct antiglobulin test (DAT) and/or reticulocytosis. Moreover, it was required that bone marrow specimens were evaluated in all DAT negative cases, in order to rule out aplastic anemia and/or anemia related to CLL progression.…”

“…Unfavorable cytogenetic deletions, i.e., del(11q)(23) and del(17p) (14), were more prevalent in CLL patients develop- (14) showed a significantly increased risk of developing AIHA (P < 0.0001, Fig. 2a).…”