Liver dysfunction in chronic lymphocytic leukemia: Prevalence, outcomes, and pathological findings - PubMed (original) (raw)

. 2017 Dec;92(12):1362-1369.

doi: 10.1002/ajh.24915. Epub 2017 Oct 19.

Kari G Chaffee 2, Rebecca L King 3, Douglas Simonetto 4, Melissa C Larson 2, Sara Achenbach 2, Timothy G Call 5, Wei Ding 5, Saad S Kenderian 5, Jose F Leis 6, Asher A Chanan-Khan 7, Deborah A Bowen 5, Michael J Conte 5, Susan M Schwager 5, Curtis A Hanson 3, Susan L Slager 2, Neil E Kay 5, Tait D Shanafelt 5, Sameer A Parikh 5

Affiliations

Liver dysfunction in chronic lymphocytic leukemia: Prevalence, outcomes, and pathological findings

Paul J Hampel et al. Am J Hematol. 2017 Dec.

Abstract

The prevalence of liver dysfunction and its association with outcomes in patients with previously untreated chronic lymphocytic leukemia (CLL) is unknown. Newly diagnosed (<12 months) previously untreated CLL patients seen at Mayo Clinic, Rochester, MN between 9/1993 and 4/2016 who had baseline assessment of at least one liver function test (LFT) were included in this analysis. The prevalence of liver dysfunction at baseline, proportion of patients who acquired LFT abnormalities, time to first therapy (TTFT) and overall survival (OS) were assessed. An abnormal LFT was present in 82/2336 (3.5%) patients at diagnosis and was associated with advanced Rai stage (Rai III-IV) (21% vs. 6%; P < .001), lower hemoglobin (13.1 g/dL vs. 13.9 g/dL; P < .001), and lower platelet count (187 × 109/L vs. 200 × 109/L; P = .03). Additionally, 236 patients with normal LFTs at diagnosis developed acquired liver dysfunction during follow-up. Patients with abnormal LFTs at diagnosis had a shorter OS compared to those with normal LFTs (HR 1.80 95% CI 1.13-2.87; P = .014, adjusted for age, sex, Rai stage, and treatment), although TTFT was not different. Of 52 patients who underwent a liver biopsy, CLL was present in liver tissue in 39/52 (73%) patients, with the portal tracts the most common region involved. Histopathology findings of liver involvement by CLL had limited correlation with choice of CLL therapy. In conclusion, approximately 1 of 25 newly diagnosed CLL patients has abnormal LFTs at diagnosis. Although the TTFT was not different among patients with abnormal LFTs, these patients have a shorter OS compared to those with normal LFTs.

© 2017 Wiley Periodicals, Inc.

PubMed Disclaimer

Figures

FIGURE 1

FIGURE 1

A, Time to first treatment comparison based on liver function test abnormalities at baseline. The median time to first treatment was 7.0 years for both the patients with abnormal liver function tests at baseline (n = 82) and those with normal testing (n = 2254). B, Overall survival comparison based on liver function test abnormalities at diagnosis. The median survival of CLL patients with abnormal liver function tests at baseline (n = 82) was 6.6 years compared to 11.6 years in those with normal testing (n = 2254)

FIGURE 2

FIGURE 2

Histopathological patterns of CLL involvement of the liver. A, Portal infiltration with sinusoidal extension (arrows), B, Portal infiltration, C, Sinusoidal predominance, D, Diffuse involvement effacing the liver parenchyma

Similar articles

Cited by

References

    1. Binet JL, Leporrier M, Dighiero G, et al. A clinical staging system for chronic lymphocytic leukemia: prognostic significance. Cancer. 1977; 40:855–864. - PubMed
    1. Rai KR, Sawitsky A, Cronkite EP, et al. Clinical staging of chronic lymphocytic leukemia. Blood. 1975;46:219–234. - PubMed
    1. Binet JL, Auquier A, Dighiero G, et al. A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer. 1981;48:198–206. - PubMed
    1. International CLL-IPI working group. An international prognostic index for patients with chronic lymphocytic leukaemia (CLL-IPI): a meta-analysis of individual patient data. Lancet Oncol. 17:779–790. - PubMed
    1. Parikh SA, Shanafelt TD. Prognostic factors and risk stratification in chronic lymphocytic leukemia. Semin Oncol. 2016;43:233–240. - PubMed

MeSH terms

LinkOut - more resources