The prevalence and prognostic significance of autoimmune cytopenias in a cohort of Egyptian patients with chronic lymphocytic leukemia

Abstract

Objective/background: The impact of autoimmune cytopenias (AICs) on the chronic lymphocytic leukemia (CLL) clinical course and its prognostic significance remain a matter of controversial debate. This could be due to exclusion of patients with cytopenia from most clinical trials for this particular complication and the lack of standard diagnostic criteria and treatment approaches. We herein evaluate the prevalence and the prognostic significance of AICs among patients with CLL.

Methods: This is an observational retrospective study. Data on 101 patients with CLL were derived from the Oncology Center, Mansoura University, Egypt, database, which contains information on demographic and clinical characteristics at diagnosis and follow-up records.

Results: The prevalence of immune cytopenias was 11.9% among patients studied. Autoimmune hemolytic anemia was the most common autoimmune form in patients with cytopenia due to pure immune etiology (C immune group) with a prevalence of 6.9%. Patients with AICs and those in the C immune subgroup presented with more unfavorable parameters. Besides, patients with AICs showed lesser response to treatment and on restaging after initial treatment, significantly more patients without AICs moved to a more favorable stage. However, no parallel significant difference in the overall survival was found between patients without AICs and those with AICs or with immune and combined or infiltrative cytopenia.

Conclusion: We have shown a prevalence of 11.8% for AIC among our CLL patients. AIC was associated with unsatisfactory normalization of the hematological parameters even with therapy and lower number of patients with CLL downstaging in comparison with patients without AIC. These results suggest that AIC is a fingerprint of a biologically more aggressive disease even if no significant impact on overall survival was found.

Keywords: Autoimmune cytopenia; Autoimmune hemolytic anemia; Chronic lymphocytic leukemia; Prognosis.