Intrinsic and treatment-related immune alterations in chronic lymphocytic leukaemia and their impact for clinical practice.
BACKGROUND
Chronic lymphocytic leukaemia patients harbour important impairments in both their cellular- and humoral-mediated immunity, which accounts for their notorious susceptibility to a multitude of infections and various autoimmune cytopenias. It has also been shown that the rate of second cancers is increased in chronic lymphocytic leukaemia.


OBJECTIVE
The aim of this study was to review the immune alterations in untreated and treated chronic lymphocytic leukaemia and define their impact for clinical practice.


METHODS
The author gives a comprehensive review of the most relevant preclinical and clinical studies pertaining to various immune abnormalities and infectious complications in both untreated and treated chronic lymphocytic leukaemia. Landmark clinical trials involving the contemporary chronic lymphocytic leukaemia chemo- and immunotherapies, alone or in combination, as well as the main epidemiological studies establishing the increased rate of second cancers in chronic lymphocytic leukaemia are also discussed.


CONCLUSIONS
Iatrogenic immunosuppression in chronic lymphocytic leukaemia alters the pattern of opportunistic infections, can cause autoimmune cytopenias and might further increase the rate of second malignancies in patients whose disease already places them at a greater risk. Careful consideration of existing risk factors in chronic lymphocytic leukaemia could establish the optimal screening and follow-up schedule for chronic lymphocytic leukaemia patients as its therapeutics evolves.
Dasanu
Constantin A
CA
Seattle Hematology-Oncology, 2202 70th Ave West, University Place, WA 98466, USA. c_dasanu@yahoo.com
D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007154:Immune System Diseases / Q000139:chemically induced*; D007108:Immune Tolerance / Q000187:drug effects*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy / Q000276:immunology; D016609:Neoplasms, Second Primary / Q000139:chemically induced / Q000453:epidemiology / Q000276:immunology; D009894:Opportunistic Infections / Q000209:etiology / Q000276:immunology
D000970:Antineoplastic Agents