title: Old DAT and new data: positive direct antiglobulin test identifies a subgroup with poor outcome among chronic lymphocytic leukemia stage A patients.
abstract: Only a minority of chronic lymphocytic leukemia (CLL) patients harboring a positive direct antiglobulin test (DAT) will develop autoimmune hemolytic anemia (AIHA). In a single institution cohort of 378 CLL patients, 56 patients (14.8%) had at least one positive DAT during the course of the disease, either at diagnosis or later. We found no relationship between the time of the first positive DAT and overall survival (OS). However, patients with a positive DAT who did not develop AIHA had the same adverse outcome as patients who developed AIHA. Of the patients who were in Binet stage A at diagnosis, those with a positive DAT had a significantly shorter OS, regardless of their IGHV mutational status, however, there was a strong association with VH1-69. By multivariate analysis, a positive DAT was found to be an independent adverse prognostic factor for OS. Thus, DAT represents a strong adverse prognostic factor and its determination should be repeated during follow-up.
authors.affiliation: CHU Reims, Hôpital Robert Debré, Service d'Hématologie Clinique, Reims, France; INSERM U978, Bobigny, France; Université Paris 13, Sorbonne Paris Cité, "Adaptateurs de Signalisation en Hématologie," Labex "Inflamex," Unité de Formation et de Recherche Santé-Médecine-Biologie Humaine, Bobigny, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Quinquenel
authors.forename: Chadi
authors.initials: C
authors.lastname: Al Nawakil
authors.forename: Fanny
authors.initials: F
authors.lastname: Baran-Marszak
authors.forename: Virginie
authors.initials: V
authors.lastname: Eclache
authors.forename: Remi
authors.initials: R
authors.lastname: Letestu
authors.forename: Mohammed
authors.initials: M
authors.lastname: Khalloufi
authors.forename: Marouane
authors.initials: M
authors.lastname: Boubaya
authors.forename: Christine
authors.initials: C
authors.lastname: Le Roy
authors.forename: Nadine
authors.initials: N
authors.lastname: Varin-Blank
authors.forename: Alain
authors.initials: A
authors.lastname: Delmer
authors.forename: Vincent
authors.initials: V
authors.lastname: Levy
authors.forename: Florence
authors.initials: F
authors.lastname: Ajchenbaum-Cymbalista
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000744:Anemia, Hemolytic, Autoimmune / Q000175:diagnosis* / Q000209:etiology / Q000276:immunology / Q000401:mortality; D015331:Cohort Studies; D015933:Complement C3d / Q000032:analysis; D003298:Coombs Test; D003627:Data Interpretation, Statistical; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D053208:Kaplan-Meier Estimate; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications / Q000175:diagnosis* / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis
chemical_list: D007074:Immunoglobulin G; D015933:Complement C3d