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
- PMID: 28940587
- PMCID: PMC7219181
- DOI: 10.1002/ajh.24915
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.
Figures
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
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
- The CLL International Prognostic Index predicts outcomes in monoclonal B-cell lymphocytosis and Rai 0 CLL.
Parikh SA, Rabe KG, Kay NE, Call TG, Ding W, Leis JF, Kenderian SS, Muchtar E, Wang Y, Koehler AB, Schwager SM, Lesnick CE, Kleinstern G, Van Dyke D, Hanson CA, Braggio E, Slager SL, Shanafelt TD. Parikh SA, et al. Blood. 2021 Jul 15;138(2):149-159. doi: 10.1182/blood.2020009813. Blood. 2021. PMID: 33876228 Free PMC article. - Hypogammaglobulinemia in newly diagnosed chronic lymphocytic leukemia: Natural history, clinical correlates, and outcomes.
Parikh SA, Leis JF, Chaffee KG, Call TG, Hanson CA, Ding W, Chanan-Khan AA, Bowen D, Conte M, Schwager S, Slager SL, Van Dyke DL, Jelinek DF, Kay NE, Shanafelt TD. Parikh SA, et al. Cancer. 2015 Sep 1;121(17):2883-91. doi: 10.1002/cncr.29438. Epub 2015 Apr 30. Cancer. 2015. PMID: 25931291 Free PMC article. - Chronic Lymphocytic Leukemia Prognostic Index: A New Integrated Scoring System to Predict the Time to First Treatment in Chinese Patients with Chronic Lymphocytic Leukemia.
Li H, Yi SH, Xiong WJ, Liu HM, Lyu R, Wang TY, Liu W, Zhong SZ, Yu Z, Zou DH, Xu Y, An G, Li ZJ, Qiu LG. Li H, et al. Chin Med J (Engl). 2017 Jan 20;130(2):135-142. doi: 10.4103/0366-6999.197978. Chin Med J (Engl). 2017. PMID: 28091403 Free PMC article. - Hematologist/oncologist disease-specific expertise and survival: lessons from chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL).
Shanafelt TD, Kay NE, Rabe KG, Inwards DJ, Zent CS, Leis JF, Schwager SM, Thompson CA, Bowen DA, Witzig TE, Slager SL, Call TG. Shanafelt TD, et al. Cancer. 2012 Apr 1;118(7):1827-37. doi: 10.1002/cncr.26474. Epub 2011 Aug 26. Cancer. 2012. PMID: 22009554 Free PMC article. - The development of marked elevation in white blood cell count does not predict inferior outcome in chronic lymphocytic leukemia.
Silverman JA, Franssen E, Buckstein R, Imrie KR. Silverman JA, et al. Leuk Lymphoma. 2002 Jun;43(6):1245-51. doi: 10.1080/10428190290026295. Leuk Lymphoma. 2002. PMID: 12152992 Review.
Cited by
- Extramedullary and extranodal manifestations in chronic lymphocytic leukemia - an update.
Robak T, Puła A, Braun M, Robak E. Robak T, et al. Ann Hematol. 2024 Sep;103(9):3369-3383. doi: 10.1007/s00277-024-05854-1. Epub 2024 Jul 25. Ann Hematol. 2024. PMID: 39052034 Free PMC article. Review. - Increased serum level of alpha-2 macroglobulin and its production by B-lymphocytes in chronic lymphocytic leukemia.
Michelis R, Milhem L, Galouk E, Stemer G, Aviv A, Tadmor T, Shehadeh M, Shvidel L, Barhoum M, Braester A. Michelis R, et al. Front Immunol. 2022 Sep 2;13:953644. doi: 10.3389/fimmu.2022.953644. eCollection 2022. Front Immunol. 2022. PMID: 36119042 Free PMC article. - The Effect of Dietary Intervention With High-Oleocanthal and Oleacein Olive Oil in Patients With Early-Stage Chronic Lymphocytic Leukemia: A Pilot Randomized Trial.
Rojas Gil AP, Kodonis I, Ioannidis A, Nomikos T, Dimopoulos I, Kosmidis G, Katsa ME, Melliou E, Magiatis P. Rojas Gil AP, et al. Front Oncol. 2022 Jan 21;11:810249. doi: 10.3389/fonc.2021.810249. eCollection 2021. Front Oncol. 2022. PMID: 35127522 Free PMC article. - The CLL International Prognostic Index predicts outcomes in monoclonal B-cell lymphocytosis and Rai 0 CLL.
Parikh SA, Rabe KG, Kay NE, Call TG, Ding W, Leis JF, Kenderian SS, Muchtar E, Wang Y, Koehler AB, Schwager SM, Lesnick CE, Kleinstern G, Van Dyke D, Hanson CA, Braggio E, Slager SL, Shanafelt TD. Parikh SA, et al. Blood. 2021 Jul 15;138(2):149-159. doi: 10.1182/blood.2020009813. Blood. 2021. PMID: 33876228 Free PMC article. - Recent advances in cardio-oncology: a report from the 'Heart Failure Association 2019 and World Congress on Acute Heart Failure 2019'.
Anker MS, Hadzibegovic S, Lena A, Belenkov Y, Bergler-Klein J, de Boer RA, Farmakis D, von Haehling S, Iakobishvili Z, Maack C, Pudil R, Skouri H, Cohen-Solal A, Tocchetti CG, Coats AJS, Seferović PM, Lyon AR; Heart Failure Association Cardio-Oncology Study Group of the European Society of Cardiology. Anker MS, et al. ESC Heart Fail. 2019 Dec;6(6):1140-1148. doi: 10.1002/ehf2.12551. Epub 2019 Dec 28. ESC Heart Fail. 2019. PMID: 31884717 Free PMC article.
References
- Binet JL, Leporrier M, Dighiero G, et al. A clinical staging system for chronic lymphocytic leukemia: prognostic significance. Cancer. 1977; 40:855–864. - PubMed
- Rai KR, Sawitsky A, Cronkite EP, et al. Clinical staging of chronic lymphocytic leukemia. Blood. 1975;46:219–234. - PubMed
- 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
- 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
- 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
Full Text Sources
Other Literature Sources
Medical