Diagnosis Of Chronic Lymphocytic Leukemia Research Articles

Real-world comparative effectiveness of first-line Bruton tyrosine kinase inhibitors (BTKis) in patients with chronic lymphocytic leukemia (CLL).

e23264 Background: Next-generation BTKi monotherapy is a preferred first-line (1L) treatment (tx) option, as categorized by the NCCN guidelines, for patients (pts) with CLL. In phase 3 randomized trials among pts with relapsed or refractory CLL, zanubrutinib (zanu) demonstrated superior efficacy vs ibrutinib (ibr), while acalabrutinib (acala) only showed noninferiority to ibr. In the absence of head-to-head trial comparison, we evaluated real-world (rw) clinical outcomes in 1L BTKi monotherapy in pts with CLL in a large US population. Methods: This is a retrospective observational study utilizing the US nationwide Flatiron Health electronic health record–derived de-identified database. Eligible pts included those with a CLL diagnosis who started 1L BTKi monotherapy between 01/01/2020 and 08/31/2024. Outcomes included rw time to next tx or death (rwTTNT), time to tx discontinuation or death (rwTTD), and overall survival (rwOS). Landmark tx and survival probabilities were estimated using Kaplan–Meier methods. Hazard ratios (HRs) and 95% CI were estimated using Cox proportional hazard models, adjusting for age, sex, race/ethnicity, practice type, ECOG performance status, IGHV, and del17p/ TP53 mutation status. Results: A total of 2515 pts with CLL were included (zanu n = 310, acala n = 1111, ibr n = 1094). 1L use of ibr decreased over time, with zanu being most common in 2024 (49% vs 44% acala, 7% ibr).Median age was 73, 74, and 72 yrs for zanu, acala, and ibr, respectively. More pts with zanu had del17p/ TP53 mutation (16% vs 12% acala, 11% ibr). Median follow-up was 12 mos for zanu, 23 for acala and 33 for ibr. Landmark tx probabilities and 95% CI are in the Table. Median rwTTNT was not reached (NR) for zanu and acala, and was 38.2 mos for ibr. Median rwTTD was NR for zanu, 43.7 mos for acala, and 21.9 for ibr. Pts on zanu had numerically higher probability of not advancing to next line of therapy and not discontinuing tx at 6, 12, and 18 mos than those on acala and ibr (Table). Median rwOS was NR for all groups. Compared to pts on ibr, pts on zanu had statistically significant lower risks of rwTTNT (HR, 0.59; 95% CI, 0.44, 0.79), rwTTD (0.56; 0.44, 0.72), and rwOS (0.46; 0.28, 0.76). Compared to pts on acala, pts on zanu had numerically lower risks of rwTTNT, rwTTD, and rwOS. Conclusions: Patients with zanu had significantly longer rwTTNT, rwTTD, and rwOS compared to those with ibr and longer trends compared to those with acala. Limitations include limited follow-up time for zanu vs ibr and acala. Zanu n=310 Acala n=1111 Ibr n=1094 rwTTNT, % (95% CI) 6 mos 91 (87, 94) 88 (86, 90) 85 (83, 87) 12 83 (77, 87) 81 (78, 83) 75 (72, 78) 18 78 (72, 84) 74 (71, 77) 67 (64, 69) rwTTD, % (95% CI) 6 mos 85 (80, 88) 81 (78, 83) 75 (72, 77) 12 76 (70, 81) 72 (69, 75) 62 (59, 65) 18 70 (63, 76) 66 (63, 69) 53 (50, 56)

Effects of sample age and storage temperature on the flow cytometric diagnosis of chronic lymphocytic leukaemia in South Africa

Background: Chronic lymphocytic leukaemia (CLL) is a haematological neoplasm with characteristic flow cytometric immunophenotyping. Pre-analytical variables impact the quality and reproducibility of flow cytometric data, which could alter the diagnosis from CLL to atypical CLL (aCLL).Objective: This study investigated the effects of pre-analytical variables, specifically sample age and storage temperature, on the stability of key antigens used in the diagnosis of CLL.Methods: Serial flow cytometric analyses were performed from January 2022 to March 2023 on blood samples of 10 CLL patients from the Universitas Academic Hospital Haematology Clinic in Bloemfontein, South Africa. Samples were stored at room and refrigerator temperatures and analysed at baseline, 24 h, 48 h, 72 h and 96 h. We recorded the percentage and intensity of antigen expression of CLL makers, including CD5, CD20, CD23, CD79b, CD200 and sIgM, and assessed whether these affected the adapted and modified Matutes scores.Results: Statistically significant changes were observed in CD5 (p = 0.028), CD23 (p = 0.003) and CD200 (p = 0.005) expression, with better stability at refrigerator temperature. Two samples showed changes in both Matutes scores by 24 h, irrespective of storage temperature. By 48 h, scores changed to aCLL in six room-temperature and four refrigerated samples. A majority shift in diagnosis to aCLL (modified Matutes: n = 8/10; adapted Matutes: n = 7/10) was observed at 96 h for refrigerated samples.Conclusion: These findings indicate that pre-analytical variables influence antigen stability in CLL samples, with better preservation at refrigerator temperature, recommending analysis within 48 h of collection.What this study adds: This study highlights the impact of pre-analytical variables on the flow cytometric diagnosis of CLL. Extended room temperature storage alters antigen expression, shifting Matutes scores and potentially affecting the final diagnosis. The findings emphasise optimised sample handling, for improved diagnostic accuracy in laboratory medicine.

The t(18;22)/IGL::BCL2 translocation defines a unique CLL subtype: association with early treatment initiation.

The most prevalent BCL2 fusion in B-cell lymphoma involves the IGH gene, attributable to the t(14;18)(q32;q21) translocation; this chromosomal abnormality is predominantly observed in follicular lymphoma (FL) and serves as one of its diagnostic hallmarks. In contrast, the fusion of BCL2 with IGL via the t(18;22)(q21;q11) translocation occurs less frequently. To investigate the clinicopathological characteristics associated with t(18;22)/IGL::BCL2, we conducted an analysis of five cases of B-cell lymphoma exhibiting the t(18;22) translocation. These patients underwent comprehensive diagnostic assessments, including pathological examination, flow cytometry, karyotyping, fluorescence in situ hybridization (FISH) testing, and genome-wide mutation analysis. Simultaneously, we conducted a literature review. All five patients in the study were male and diagnosed with chronic lymphocytic leukemia (CLL). Two patients exhibited an isolated t(18;22) chromosomal abnormality, while the remaining three presented with an additional +12 abnormality. Genetic rearrangements involving BCL2 and IGL were observed in all patients. Immunophenotypic analysis revealed no significant differences between classical CLL and cases with the t(18;22)/IGL::BCL2 translocation. Genetic testing conducted on three patients confirmed the presence of IGHV mutations. Of the three patients for whom treatment information was available, one demonstrated treatment indications at the initial diagnosis, one demonstrated treatment indications 14months later, both of them did not respond to the Bruton's tyrosine kinase (BTK) inhibitor, and another one did not meet criteria for treatment. A comprehensive literature review identified 51 cases of the t(18;22)(q21;q11) translocation, primarily associated with CLL diagnoses. Detailed clinical trajectories were available for seven patients, among whom four required treatments at initial diagnosis, and two exhibited resistance to BTK inhibitors. Based on our case series and literature review, these cases appeared to have shorter time to first treatment(TTFT); however, more studies are needed. The t(18;22) chromosomal translocation, resulting in IGL::BCL2 fusion, is an infrequent occurrence predominantly observed in cases of CLL. This genetic anomaly frequently coexists with trisomy 12. Preliminary data suggest that these cases may have a shorter TTFT, though larger cohorts are needed for validation.

CLLAF SCORE-A New Risk Score for Predicting Atrial Fibrillation in Treatment-Naive CLL Patients Initiating First- and Second-Generation BTK Inhibitor Therapy.

One of the limiting toxicities of BTKi is the development of atrial fibrillation (AF), with an incidence of 3%-16%. This study aimed to identify patients with chronic lymphocytic leukemia (CLL) starting both first- and second-generation BTKis who are at high risk of developing AF using a machine learning approach. The CLL cohort is based on data obtained from electronic medical records from Maccabi, the second-largest healthcare organization in Israel. The optimal scoring model was determined using the Risk-calibrated Supersparse Linear Integer Model (RiskSLIM) algorithm. A total of 3964 patients with a CLL diagnosis were available in the database. Of these, 208 patients started BTKi during the study period (125 on ibrutinib and 83 on acalabrutinib), and 16 patients developed AF during follow-up. In addition to well-established factors such as age, sex, and hypertension, the algorithm detected other factors associated with a high risk for AF: type of BTKi used, low eGFR, elevated absolute monocytes (> 1100/μL), elevated CRP, elevated CK, and elevated B2MG (> 2.5 mg/L). Based on the total AF-free survival (AFS), we identified three main risk groups: low (0-6), intermediate (7-11) and high (≥ 12). The median AF-free survival (AFS) was 28 and 56 months for the high-risk and intermediate-risk groups, respectively, and was not reached for the low-risk group. The difference between the groups was statistically significant (p = 0.0013). Our novel score has a high concordance index for predicting the development of AF in patients with CLL treated with first- and second-generation BTKis. It combines age, sex, medical history, and laboratory tests associated with inflammatory status and disease burden and can be applied in clinical settings worldwide.

A Distinctive Case of Hemophagocytic Lymphohistiocytosis in Chronic Lymphocytic Leukemia.

Chronic lymphocytic leukemia (CLL) is an indolent malignancy characterized by the accumulation of dysfunctional B-cell lymphocytes. Complications such as hemophagocytic lymphohistiocytosis (HLH) can arise, particularly during disease progression. HLH has been increasingly reported as a complication of CLL, often triggered by factors such as superimposed infections, chemotherapy, Richter transformation, or disease progression. This case explores HLH as an initial presentation of undiagnosed CLL without any identifiable trigger. We present the case of a 65-year-old woman who presented with a high-grade fever, sore throat, and pancytopenia. Despite broad-spectrum antibiotic treatment, her condition deteriorated. Investigations revealed elevated ferritin levels, low natural killer cell activity, and other findings consistent with HLH. Flow cytometry and bone marrow biopsy ultimately confirmed the diagnosis of CLL. HLH is characterized by the hyperactivation of immune cells and is known to be triggered by a variety of factors, including infections and malignancies. In this case, the absence of identifiable triggers raises important questions about the underlying pathophysiology linking HLH with CLL. While previous reports have highlighted HLH as a complication of CLL, typically secondary to infection or treatment, this case is particularly noteworthy due to the unexplained onset of HLH in the absence of such triggers. This case underscores the need for heightened awareness of HLH as a potential manifestation of underlying malignancy, especially in non-septic patients presenting with unexplained fever and pancytopenia. In addition, the simultaneous presentation of normal pressure hydrocephalus emphasizes the complex interplay of inflammatory processes in CLL. Further research is needed to explore the relationship between inflammation and the pathogenesis of CLL.

Co-existence of Untreated Chronic Lymphocytic Leukaemia and Acute Myeloid Leukaemia: A Rare Case of Synchronous Dual Haematological Malignancy

The occurrence of Acute Myeloid Leukaemia (AML) or Myelodysplastic Syndrome (MDS) in patients with Chronic Lymphocytic Leukaemia (CLL) is rare. In most of the reported cases, AML occurs after treatment of CLL with cytotoxic drugs suggesting that AML may be a secondary leukaemia (therapy-related AML). AML or MDS occurring in untreated CLL patients is extremely rare with isolated case reports. Herein, we report the case of a 74-year-old male patient who was diagnosed four months back to have chronic B cell lymphoproliferative disorder, from an outside centre. The patient did not receive any treatment. Because of intermittent fever and increased fatigability, he came to our centre. Peripheral blood smear and bone marrow studies showed a dual population of atypical cells-one population of large immature cells with opened-up chromatin, prominent nucleoli, and another population of small atypical lymphocytes with clumped chromatin. Around 10% of immature cells showed Myeloperoxidase (MPO) positivity. Flow cytometric analysis also showed two separate populations of cells. The immunophenotype of one population was compatible with AML, with monocytic differentiation, and the second population showed features of CLL. A diagnosis of coexistent CLL and AML was given. The awareness of the co-existence of dual haematological malignancy, thorough morphological evaluation, and flow cytometric immunophenotyping will lead to accurate diagnosis of these combined malignancies.

Lacrimal Sac CLL: A Review of Clinical Features, Investigations, and Management.

This study reviews all reported cases of lacrimal gland chronic lymphocytic leukemia (CLL) to identify patterns in clinical presentation, diagnosis, and management to aid in early recognition and treatment of this uncommon occurrence. A comprehensive search of medical literature databases was performed to identify studies reporting lacrimal sac involvement in CLL from 1970 to 2024. Data were extracted regarding demographics, symptoms, diagnostic methods, treatment, and outcomes. Thirty-three cases of CLL lacrimal sac infiltration were identified. The median age was 71, with a slight female predominance of 54.5%. The most common symptoms were epiphora (63.6%) and pseudo-dacryocystitis or symptoms of dacryocystitis (48.5%). A significant proportion of patients (87.9%) had a known history of CLL at presentation. Chemotherapy combined with surgery was the most frequent treatment, 48.4%, with a positive response in 93.3% of patients. Local recurrence occurred in 10.3% of cases, predominantly in those treated with chemotherapy and surgery, or surgery alone. Lacrimal sac CLL, though rare, should be considered in patients with nasolacrimal duct obstruction, especially those with a prior CLL diagnosis. Early diagnosis can be aided by imaging and histopathological evaluation, and treatment typically results in favorable outcomes with low recurrence rates. Tailoring treatment based on individual patient factors is essential for optimal management.

Pleural involvement revealing chronic lymphocytic leukemia: A case report

Pleural involvement revealing chronic lymphocytic leukemia (CLL) is a rare phenomenon. CLL is a hematologic malignancy characterized by an excessive proliferation of B lymphocytes. Although CLL typically presents with symptoms such as fatigue, frequent infections, and lymphadenopathy, in some cases, it may initially manifest with pleural involvement. This involvement can present as a pleural effusion, leading to symptoms such as dyspnea, chest pain, and a dry cough. Diagnosis relies on cytological analysis of pleural fluid, biopsy, and additional tests such as immunophenotyping. Management includes treatment of the underlying CLL, often with a combination of chemotherapy and immunotherapy. We report the case of a 53-year-old male, a former farmer and chronic smoker, who presented with stage III dyspnea (according to Sadoul), dry cough, and right-sided lower thoracic pain. These symptoms were associated with a general decline in his health status. Clinical examination revealed signs of right-sided pleural effusion, multiple lymphadenopathies (cervical, axillary, inguinal), and hepatosplenomegaly. Laboratory tests showed significant lymphocytosis. A pleural puncture revealed a lymphocytic exudative fluid, and pleural biopsy showed granulomatous inflammation without caseous necrosis. Immunohistochemistry highlighted an abnormal population of B lymphocytes expressing CD19, CD5, CD20, CD23 markers, and a monoclonal population with a predominance of the kappa light chain, thus confirming the diagnosis of chronic lymphocytic leukemia. After confirmation of the stage C CLL diagnosis, the patient was treated with chemotherapy (CHOP protocol).

ENPP2 promotes progression and lipid accumulation via AMPK/SREBP1/FAS pathway in chronic lymphocytic leukemia

BackgroundDisorders of lipid metabolism are critical factors in the progression of chronic lymphocytic leukemia (CLL). However, the characteristics of lipid metabolism and related regulatory mechanisms of CLL remain unclear.MethodsHence, we identified altered metabolites and aberrant lipid metabolism pathways in patients with CLL by ultra-high-performance liquid chromatography-mass spectrometry-based non-targeted lipidomics. A combination of transcriptomics and lipidomics was used to mine relevant target molecule and downstream signaling pathway. In vitro cellular assays, quantitative real-time polymerase chain reaction (qRT-PCR), western blot, fluorescent staining, RNA sequencing, and coimmunoprecipitation were used to monitor the molecular levels as well as to explore the underlying mechanisms.ResultsSignificant differences in the content of 52 lipid species were identified in CLL samples and healthy controls. Functional analysis revealed that alterations in glycerolipid metabolism, glycerophospholipid metabolism, sphingolipid metabolism, and metabolic pathways had the greatest impact on CLL. On the basis of the area under the curve value, a combination of three metabolites (phosphatidylcholine O-24:2_18:2, phosphatidylcholine O-35:3, and lysophosphatidylcholine 34:3) potentially served as a biomarker for the diagnosis of CLL. Furthermore, utilizing integrated lipidomic, transcriptomic, and molecular studies, we reveal that ectonucleotide pyrophosphatase/phosphodiesterase 2 (ENPP2) plays a crucial role in regulating oncogenic lipogenesis. ENPP2 expression was significantly elevated in patients with CLL compared with normal cells and was validated in an independent cohort. Moreover, ENPP2 knockdown and targeted inhibitor PF-8380 treatment exerted an antitumor effect by regulating cell viability, proliferation, apoptosis, cell cycle, and enhanced the drug sensitivity to ibrutinib. Mechanistically, ENPP2 inhibited AMP-activated protein kinase (AMPK) phosphorylation and promoted lipogenesis through the sterol regulatory element-binding transcription factor 1 (SREBP-1)/fatty acid synthase (FAS) signaling pathway to promote lipogenesis.ConclusionsTaken together, our findings unravel the lipid metabolism characteristics of CLL. Moreover, we demonstrate a previously unidentified role and mechanism of ENPP2 in regulation of lipid metabolism, providing a novel therapeutic target for CLL treatment.

Atrial Fibrillation Management and Outcomes in Bruton's Tyrosine Kinase Inhibitor Treated Chronic Lymphocytic Leukemia Patients

Atrial Fibrillation Management and Outcomes in Bruton's Tyrosine Kinase Inhibitor Treated Chronic Lymphocytic Leukemia Patients

Baseline Characteristics from Arise Study, an Italian Non-Interventional Study Assessing the Real-World Use of Acalabrutinib in the Treatment of Patients with Chronic Lymphocytic Leukemia (CLL)

Baseline Characteristics from Arise Study, an Italian Non-Interventional Study Assessing the Real-World Use of Acalabrutinib in the Treatment of Patients with Chronic Lymphocytic Leukemia (CLL)

De Novo DLBCL with Concurrent Monoclonal B-Cell Lymphocytosis CLL-Type Exhibits Biological Characteristics Similar to Richter Syndrome

De Novo DLBCL with Concurrent Monoclonal B-Cell Lymphocytosis CLL-Type Exhibits Biological Characteristics Similar to Richter Syndrome

A 47-Year-old Asian female with tracheobronchial space-occupying lesions caused by chronic lymphocytic leukemia

Case presentationA 47-year-old Asian woman was admitted with worsening chest tightness and dyspnea for 10 days. Computed tomography (CT) showed changes in the trachea and segmental bronchi. Pulmonary function results suggestive of severe obstructive ventilatory dysfunction. Bronchoscopic findings showed the presence of multiple nodular lesions in the patient’s trachea and left and right main bronchi. Bronchoscopic biopsy, lymph node biopsy and bone marrow aspiration flow cytometry test results led to a definitive diagnosis of chronic lymphocytic leukemia (CLL), staged as Binet stage B and Rai stage 2.

Mantle cell lymphoma with skin involvement: Case report of a rare manifestation in a patient with initial diagnosis of chronic lymphocytic leukemia

Mantle cell lymphoma is a rare subtype of B-cell non-Hodgkin's lymphoma, which mainly affects males. It has a variable clinical presentation, with a course ranging from indolent cases that do not require treatment for years to very aggressive cases. Skin involvement is a rare event. Although most patients have disease in stage III or IV at diagnosis, they generally present with good functional status. In immunohistochemistry, CD5 is commonly expressed, a feature it shares with chronic lymphocytic leukemia. Cyclin D1 and SOX11 expression are present in almost all cases. Treatment depends on multiple factors such as age, frailty, comorbidities, disease stage, symptoms and morphological characteristics. We present the case of a male patient initially diagnosed with chronic lymphocytic leukemia who was started on treatment with ibrutinib. A biopsy of the right earlobe was subsequently performed, which documented secondary skin involvement due to a classic histological variant of mantle cell lymphoma. The patient was treated with chemotherapy between March and July 2022, with positron emission tomography at the end of the proposed cycles with complete metabolic response, so maintenance treatment with rituximab was performed and subsequently consolidated with an autologous bone marrow transplant. To date, the patient is in remission of the disease.

Atezolizumab, venetoclax, and obinutuzumab combination in Richter transformation diffuse large B-cell lymphoma (MOLTO): a multicentre, single-arm, phase 2 trial

Atezolizumab, venetoclax, and obinutuzumab combination in Richter transformation diffuse large B-cell lymphoma (MOLTO): a multicentre, single-arm, phase 2 trial

Infections and their prognostic significance before diagnosis of chronic lymphocytic leukemia, non-Hodgkin lymphoma, or multiple myeloma

BackgroundImmunodeficiency is a shared feature of B cell malignancies. The risk of infections and their prognostic significance after diagnosis are well characterized, but, conversely, less is known about prediagnostic infections in these domains.MethodsIn matched case-control analyzes, using Danish nationwide registers, we assessed the rate of prediagnostic infections in chronic lymphocytic leukemia (CLL), diffuse large B cell lymphoma (DLBCL), multiple myeloma (MM), follicular lymphoma (FL), marginal zone lymphoma (MZL), and lymphoplasmacytic lymphoma (LPL). Survival analyzes of data from clinical registers were then used to determine the effect of infections in the year preceding diagnosis on overall survival. To yield results for as many patients as possible, antimicrobial prescriptions were used as surrogates for infections.ResultsThe nationwide and clinical registers comprised 30,389 patients, accumulating 213,649 antimicrobial prescriptions, and 18,560 patients accumulating 107,268 prescriptions, respectively. The relative risk of infections was increased up to 15 years prior to diagnosis of malignancy and markedly increased in the year just prior to diagnosis. More than two antimicrobials within one year prior to diagnosis were associated with significantly shorter overall survival, independently of known prognostic factors.ConclusionPatients with B cell-derived malignancies exhibit marked immunodeficiency several years prior to diagnosis such that different disease subtypes demonstrate both overlapping and distinct trends in infection risk preceding diagnosis. Moreover, multiple infections within the year preceding diagnosis are independently associated with shorter overall survival for all the examined malignancies.

Laboratory analysis of 124 chronic lymphocytic leukemia cases: Single center study

Abstract BACKGROUND: Chronic lymphocytic leukemia (CLL) is a disease characterized by an uncontrolled proliferation of malfunctioning mature B-lymphocytes. It represents a variable range of clinical presentation and prognoses. Understanding the demographic and cellular characteristics of CLL patients can aid in better disease management and treatment outcomes. OBJECTIVES: To identifying hematological parameters and patterns and potential markers that could assist in better diagnosis and of CLL in the local population. PATIENTS, MATERIALS AND METHODS: A retrospective analysis of 124 cases of newly diagnosed CLL was conducted. Data were collected from reports over 2 years (April 2022-April2024), including demographics, Hb levels, WBC counts, platelet counts and expression of CD markers (5, 19, 20, 23, 200, FMC7, LAIR1 and others) using flow cytometry on peripheral blood specimens. Based on FC findings, patients were categorized into two groups for better assessment; definite diagnosis CLL and possible diagnosis CLL; then further subdivided into poor prognosis CLL and good prognosis CLL. RESULTS: Male patients represented 59.5% of cases and females were 40.5% with a median age of 61 years at diagnosis. The mean Hb level was 109 ± 2 g/L, the mean WBC count was 58.0 ± 25.0 × 109/L, and the mean platelet count was 190 ± 40 × 109/L. CD5 was positive in 97.6% of cases, with CD23 in 96%. CONCLUSION: This study provides an overview of the demographic and cellular marker characteristics of CLL patients in FC unit. The findings underscore the heterogeneity of CLL immunophenotype and the importance of detailed characterization in improving patient management protocols; however, further research is warranted to correlate these findings with other parameters of disease burden and prognosis to optimize the therapeutic approaches for CLL patients.

Central nervous system involvement of chronic lymphocytic leukaemia: A rare case report

Central nervous system (CNS) involvement in chronic lymphocytic leukemia (CLL) is unfamiliar. The diagnosis is delayed commonly, because of underdiagnosis or subclinical symptoms. We describe a 80-year-old woman with a previous diagnosis of CLL who presented to the emergency service with tonic clonic seizure. The new therapies, eg, ibrutinib and venetoclax, can be effective treatment strategies for CLL with CNS involvement. In our case, treatment with ibrutinib led to a resolution of the cerebralspinal fluid (CSF) neoplastic infiltration, but the patient died afterwards.

Unmutated IGHV at diagnosis in patients with early stage CLL independently predicts for shorter follow-up time to first treatment (TTFT)

Unmutated IGHV at diagnosis in patients with early stage CLL independently predicts for shorter follow-up time to first treatment (TTFT)

Unveiling a low-hanging fruit: Single-center study on secondary immunodeficiency in newly diagnosed chronic lymphocytic leukemia and multiple myeloma.

e23215 Background: Infectious complications are the leading cause of morbidity and mortality in patients with chronic lymphocytic leukemia(CLL) and multiple myeloma(MM). Despite recognized risks, evaluation of immune function occurs inconsistently. Our retrospective study evaluated practice patterns for assessing secondary immunodeficiency (SID) in newly diagnosed CLL and MM patients. Our aim is to identify areas for improvement to guide future prospective studies. Methods: We analyzed various immune parameters in newly diagnosed CLL and MM patients at Rochester Regional Health, Rochester, NY, focusing on the first six months of their clinical course, with descriptive data analysis. Results: Conclusions: Current infection prevention guidelines for newly diagnosed CLL and MM patients lack robust evidence. Despite our study’s inherent limitations (small, retrospective, single-center), based on our clinical experience, we propose the following recommendations: Complete SID assessment in all new diagnoses of CLL and MM, and this should include not only Ig levels but also vaccine response. If found to have abnormal SID evaluation, consider prophylactic antibiotics and Ig replacement, and consider reevaluation when appropriate to better define the duration of immunoparesis. Consider short-term Ig replacement (irrespective of IgG levels) and antibacterial prophylaxis for all newly diagnosed MM patients due to high infection risk during the initial six months. A thorough immune evaluation is non-invasive and low-cost, yet it can reveal clinically significant immune dysfunction, potentially influencing management in CLL and MM. Consequently, we hope our study will prompt the development of prospective, randomized studies to systematically evaluate these recommendations. [Table: see text]