title: Autoimmune cytopenias in chronic lymphocytic leukemia at disease presentation in the modern treatment era: is stage C always stage C?
abstract: Abstract Anemia and thrombocytopenia at chronic lymphocytic leukemia (CLL) presentation have long been considered to be predictive of a poor prognosis, irrespective of the cause of cytopenia, yielding an advanced stage of the disease. We identified 86 patients with CLL who were diagnosed after year 2000 with Binet C disease at first presentation. Cytopenia was considered related to autoimmune conditions in 27 (31.3%; stage C "immune") or secondary to bone marrow failure in 59 (68.6%; stage C "infiltrative"). No difference in clinical characteristics, mutational status, cytogenetics, TP53 and NOTCH1 mutations was observed between stage C "immune" and "infiltrative." Patients with stage C "immune" had a trend toward a better overall survival than patients with stage C "infiltrative" (median 74 vs. 63 months), but the difference was not statistically significant (p = 0.30). This difference was not modified by adjustment for CLL tumor burden at presentation, and survival of stage C "immune" patients was significantly inferior compared to an unselected cohort of patients with stage A, but similar to stage B. Our findings suggest that autoimmune cytopenias at CLL diagnosis have a negative impact on patient outcome.
authors.affiliation: Department of Hematology, S. Bortolo Hospital , Vicenza , Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Visco
authors.forename: Agostino
authors.initials: A
authors.lastname: Cortelezzi
authors.forename: Francesca
authors.initials: F
authors.lastname: Moretta
authors.forename: Erika
authors.initials: E
authors.lastname: Falisi
authors.forename: Francesco
authors.initials: F
authors.lastname: Maura
authors.forename: Silvia
authors.initials: S
authors.lastname: Finotto
authors.forename: Wilma
authors.initials: W
authors.lastname: Barcellini
authors.forename: Achille
authors.initials: A
authors.lastname: Ambrosetti
authors.forename: Antonino
authors.initials: A
authors.lastname: Neri
authors.forename: Marco
authors.initials: M
authors.lastname: Ruggeri
authors.forename: Francesco
authors.initials: F
authors.lastname: Rodeghiero
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001327:Autoimmune Diseases / Q000209:etiology*; D001853:Bone Marrow / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009367:Neoplasm Staging; D010198:Pancytopenia / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D007143:Immunoglobulin Heavy Chains
keywords: Binet C; Chronic lymphocytic leukemia; Rai stage 4; autoimmune disease; autoimmune hemolytic anemia; immune thrombocytopenia