title: 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 x 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 x 10(9)/L (range, 1-71 x 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.
authors.affiliation: Department of Hematology, Ospedale San Bortolo, Vicenza, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Visco
authors.forename: Marco
authors.initials: M
authors.lastname: Ruggeri
authors.forename: Maria
authors.initials: M
authors.lastname: Laura Evangelista
authors.forename: Roberto
authors.initials: R
authors.lastname: Stasi
authors.forename: Roberta
authors.initials: R
authors.lastname: Zanotti
authors.forename: Ilaria
authors.initials: I
authors.lastname: Giaretta
authors.forename: Achille
authors.initials: A
authors.lastname: Ambrosetti
authors.forename: Domenico
authors.initials: D
authors.lastname: Madeo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pizzolo
authors.forename: Francesco
authors.initials: F
authors.lastname: Rodeghiero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015996:Survival Rate; D013921:Thrombocytopenia / Q000150:complications* / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome