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Autoimmunity in chronic lymphocytic leukemia

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Chronic lymphocytic leukemia (CLL) is associated with the immune-mediated disorders autoimmune hemolytic anemia and immune thrombocytopenia. Initial treatment with corticosteroids is often successful in controlling these manifestations, but splenectomy should be considered if a rapid and complete response is not obtained. For those with persistent anemia or thrombocytopenia after splenectomy, treatment directed against the underlying CLL may be considered, although the use of purine analogues has also precipitated autoimmune hemolytic anemia. Pure red cell aplasia has been reported in CLL, and usually responds to immunosuppressive therapy.

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References and Recommended Reading

  1. Rozman C, Montserrat E: Chronic lymphocytic leukemia. N Engl J Med 1995, 333:1052–1057.

    Article  PubMed  CAS  Google Scholar 

  2. O’Brien S, del Gigilio A, Keating M: Advances in the biology and treatment of B-cell chronic lymphocytic leukemia. Blood 1995, 85:307–318.

    PubMed  CAS  Google Scholar 

  3. Rai KR, Sawitsky A, Cronkite EP, et al.: A new prognostic classification of chronic lymphocytic leukemia. Blood 1975, 46:219–234.

    PubMed  CAS  Google Scholar 

  4. Binet JL, Auguier A, Dighiero G, et al.: A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer 1981, 48:198–216.

    Article  PubMed  CAS  Google Scholar 

  5. Bartik MM, Welker D, Kay NE: Impairments in immune cell function in B-cell chronic lymphocytic leukemia. Semin Oncol 1998, 25:27–33.

    PubMed  CAS  Google Scholar 

  6. Mauro FR, Foa R, Cerretti R, et al.: Autoimmune hemolytic anemia in chronic lymphocytic leukemia: clinical, therapeutic, and prognostic features. Blood 2000, 95:2786–2792. This study reviews AIHA in a series of 1203 patients with CLL, and details the risk factors and treatment. This series suggests that steroids may be more useful in CLL-associated AIHA than in AIHA without an associated lymphoproliferative disorder.

    PubMed  CAS  Google Scholar 

  7. Diehl LF, Ketchum LH: Autoimmune disease and chronic lymphocytic leukemia: autoimmune hemolytic anemia, pure red cell aplasia, and autoimmune thrombocytopenia. Semin Oncol 1998, 25:80–97. This recent review article details autoimmune disease associated with CLL as well as other hematopoietic malignancies. A comprehensive list of interventions and their results is provided, with 151 references.

    PubMed  CAS  Google Scholar 

  8. Zipps T, Carson DA: Autoantibodies in chronic lymphocytic leukemia and related systemic autoimmune diseases. Blood 1993, 81:2475–2487.

    Google Scholar 

  9. Rai KR, Peterson BL, Frederick R, et al.: Fludarabine compared with chlorambucil as primary therapy for chronic lymphocytic leukemia. N Engl J Med 2000, 343:1750–1757. This randomized, prospective trial of 509 patients represents the most recent and best data about treatment of CLL, suggesting better response rates and longer remissions with fludarabine, but no change in overall survival.

    Article  PubMed  CAS  Google Scholar 

  10. Pritsch O, Maloum K, Dighiero G: Basic biology of autoimmune phenomena in chronic lymphocytic leukemia. Semin Oncol 1998, 25:34–41.

    PubMed  CAS  Google Scholar 

  11. George JN, El-Harake MA, Raskob GE: Chronic idiopathic thrombocytopenic purpura. N Engl J Med 1994, 331:1207–1211. This concise review summarizes the state of the art in management of chronic ITP.

    Article  PubMed  CAS  Google Scholar 

  12. Julisson G: Complications in the treatment of CLL with purine analogues. Hematol Cell Ther 1997, 39({supp}):S41-S44.

    Article  Google Scholar 

  13. Bastion Y, Coiffer B, Dumontet C, et al.: Severe autoimmune hemolytic anemia in two patients treated with fludarabine for CLL. Ann Oncol 1992, 3:171–172.

    PubMed  CAS  Google Scholar 

  14. Tosti S, Caruso R, D’Adamo F, et al.: Severe autoimmune hemolytic anemia in a patient with CLL responsive to fludarabine-based treatment. Ann Hematol 1992, 65:238–239.

    Article  PubMed  CAS  Google Scholar 

  15. Chasty RC, Myint H, Oscier DG, et al.: Autoimmune haemolysis in patients with B-CLL treated with chlorodeoxyadenosine. Leuk Lymphoma 1998, 29:391–398.

    PubMed  CAS  Google Scholar 

  16. Myint H, Copplestone JA, Orchard J, et al.: Fludarabine related autoimmune haemolytic anemia in patients with chronic lymphocytic leukemia. Br J Haematol 1995, 91:341–344.

    PubMed  CAS  Google Scholar 

  17. Schlegel PJ, Samlowski WE, Ward JH: Autoimmune hemolytic anemia in a patient with chronic lymphocytic leukemia and renal cell carcinoma after treatment with high-dose intravenous bolus Interleukin-2. J Immunother 2000, 23:507–508.

    Article  PubMed  CAS  Google Scholar 

  18. Berchtold P, McMillan R: Therapy of chronic idiopathic thrombocytopenia purpura. Blood 1989, 74:2309–2317.

    PubMed  CAS  Google Scholar 

  19. Weeks JC, Tierney MR, Weinstein MC: Cost effectiveness of prophylactic intravenous immune globulin in chronic lymphocytic leukemia. N Engl J Med 1991, 325:81–86.

    Article  PubMed  CAS  Google Scholar 

  20. Anderson JC: Response of resistant idiopathic thrombocytopenic purpura to pulsed high-dose dexamethasone therapy. N Engl J Med 1994, 330:1560–1564.

    Article  Google Scholar 

  21. Reiner A, Gensheimer, Slichter SJ: Pulse cyclophosphamide therapy for refractory autoimmune thrombocytopenic purpura. Blood 1995, 85:351–358.

    PubMed  CAS  Google Scholar 

  22. Figueroa M, Gehlsen J, Hammond D, et al.: Combination chemotherapy in refractory immune thrombocytopenia. N Engl J Med 1993, 328:1226–1229.

    Article  PubMed  CAS  Google Scholar 

  23. Facon T, Caulier MT, Fenaux P, et al.: Accessory spleen in recurrent chronic immune thrombocytopenic purpura. Am J Hematol 1992, 41:184–189.

    Article  PubMed  CAS  Google Scholar 

  24. Calverley DC, Jones GW, Kelton JG: Splenic radiation for corticosteroid-resistant immune thrombocytopenia. Ann Intern Med 1992, 116:977–981.

    PubMed  CAS  Google Scholar 

  25. Juliusson G, Elmhom-Rosenborg A, Liliemark J:Response to 2-chlorodeoxyadenosine in patient with B-cell chronic lymphocytic leukemia resistant to fludarabine. N Engl J Med 1992, 327:1056–1061.

    Article  PubMed  CAS  Google Scholar 

  26. Saven A, Lemon RH, Kosty M, et al.: 2-Chlorodeoxyadenosine activity in patients with untreated chronic lymphocytic leukemia. J Clin Oncol 1995, 13:570–574.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Internal Medicine, Huntsman Cancer Institute, University of Utah School of Medicine, 2000 Circle of Hope, Suite 2100, 84112-5550, Salt Lake City, UT, USA

    John H. Ward MD

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  1. John H. Ward MD
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Ward, J.H. Autoimmunity in chronic lymphocytic leukemia. Curr. Treat. Options in Oncol. 2, 253–257 (2001). https://doi.org/10.1007/s11864-001-0039-z

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