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Laurenti L, Scarfò L, Frustaci AM, Sanna A, Iannella E, Caira M, Finsinger P, Schifano S, Neri B, Molica S, Mauro FR. Real-world evidence on venetoclax in chronic lymphocytic leukemia: The Italian experience. Hematol Oncol 2023; 41:621-630. [PMID: 36680368 DOI: 10.1002/hon.3122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
Chronic lymphocytic leukemia (CLL) is the most common form of adult leukemia in the western world. In Italy, venetoclax was approved for use in patients with CLL as monotherapy in 2017 and in combinations in 2019. As a result of this delayed approval, there are relatively few real-world studies from Italian clinical practice and much of the data are in heavily pretreated patients. We have collected the available studies in Italian routine practice. Three studies confirm the effectiveness and tolerability of this agent in patients with relapsed/refractory CLL and high-risk disease characteristics, many of whom had received prior B-cell receptor signaling treatment. Addition of rituximab to venetoclax produced more complete responses in patients with relapsed/refractory CLL, while higher disease burden and progression while receiving a prior Bruton's tyrosine kinase inhibitor were both associated with poorer outcomes in patients treated with venetoclax. Venetoclax was well-tolerated with low discontinuation rates. No studies of venetoclax plus obinutuzumab for the first-line treatment of patients with CLL were available due to the short time since approval in Italy. Several cohorts addressed the impact of COVID-19 on patient management and outcomes, suggesting that treated patients and those in clinical observation had similar rates of COVID-19-related hospital admission, intensive care unit admission, and mortality. Overall, the responses and tolerance to venetoclax observed in the Italian real-world setting confirm the tolerability and effectiveness of venetoclax regimens in high-risk patients.
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Affiliation(s)
- Luca Laurenti
- Diagnostic Imaging, Oncological Radiotherapy and Hematology, IRCCS Agostino Gemelli University Policlinic, Rome, Italy
| | - Lydia Scarfò
- Strategic Research Program on CLL, Division of Experimental Oncology, Università Vita Salute and IRCCS San Raffaele Hospital Milan, Milan, Italy
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2
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Hochman MJ, Martin DB. Coincidence of autoimmune hemolytic anemia and pure red cell aplasia in a patient with CLL. Ann Hematol 2020; 100:579-580. [PMID: 32548659 DOI: 10.1007/s00277-020-04091-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/13/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Michael J Hochman
- Department of Medicine, University of Washington Medical Center, 825 Eastlake Ave E, Seattle, WA, 98109, USA
| | - Daniel B Martin
- Department of Medicine, University of Washington Medical Center, 825 Eastlake Ave E, Seattle, WA, 98109, USA. .,Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA, 98109, USA.
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3
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Autoimmune hemolytic anemia (AIHA) associated with chronic lymphocytic leukemia in the current era of targeted therapy. Leuk Res 2016; 50:31-36. [DOI: 10.1016/j.leukres.2016.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/16/2016] [Accepted: 09/01/2016] [Indexed: 12/13/2022]
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4
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Morande PE, Borge M, Abreu C, Galletti J, Zanetti SR, Nannini P, Bezares RF, Pantano S, Dighiero G, Oppezzo P, Gamberale R, Giordano M. Surface localization of high-mobility group nucleosome-binding protein 2 on leukemic B cells from patients with chronic lymphocytic leukemia is related to secondary autoimmune hemolytic anemia. Leuk Lymphoma 2015; 56:1115-22. [DOI: 10.3109/10428194.2014.957205] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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5
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Sartori A, Staley B, Skipper A. Drug-induced autoimmune hemolytic anemia in a 78-year-old African-American man with chronic lymphocytic leukemia. Lab Med 2014; 45:e105-8. [PMID: 25157090 DOI: 10.1309/lmlwqdb2q6ls7vqg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PATIENT 78-year-old African-American man. PAST MEDICAL HISTORY Chronic lymphocytic leukemia first diagnosed in 2003, with a subsequent relapse in 2006 and another in 2010. HISTORY OF PRESENT ILLNESS In late 2011, the patient was admitted to the hospital for cholelithiasis, at which time his treating physician incidentally discovered severe anemia. The anemia worsened as time went on, and the patient became transfusion dependent. Hypogammaglobulinemia secondary to chronic lymphocytic leukemia (CLL) required that the patient receive intravenous immunoglobulin. Despite transfusion therapy, the anemia failed to lessen; laboratory results eventually led to the diagnosis of a drug-induced warm autoantibody that triggered hemolytic anemia. MEDICATIONS The patient had taken rituximab in 2003; rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (R-CHOP) in 2006; fludarabine, cyclophosphamide, and rituximab (FCR) in 2010; and intravenous Immunoglobulin (IVIG) and prednisone in 2011.
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Affiliation(s)
- Alex Sartori
- Medical Laboratory Sciences Program, University of North Florida, Jacksonville, FL
| | - Brian Staley
- Southeastern division, Immucor, Inc., Norcross, GA
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6
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Patel SS, Aasen GA, Dolan MM, Linden MA, McKenna RW, Rudrapatna VK, Trottier BJ, Drawz SM. Early Diagnosis of Intravascular Large B-Cell Lymphoma: Clues From Routine Blood Smear Morphologic Findings. Lab Med 2014; 45:248-52; quiz e93. [DOI: 10.1309/lmsveokln18m5xtv] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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7
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Haddad H, Mohammad F, Dai Q. Bendamustine-induced immune hemolytic anemia in a chronic lymphocytic leukemia patient: A case report and review of the literature. Hematol Oncol Stem Cell Ther 2014; 7:162-4. [PMID: 24785506 DOI: 10.1016/j.hemonc.2014.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 03/24/2014] [Accepted: 04/07/2014] [Indexed: 11/26/2022] Open
Abstract
Bendamustine is an alkylating agent approved for the treatment of chronic lymphocytic leukemia (CLL) and B-cell non-Hodgkin lymphoma. There are scant reports on bendamustine-induced immune hemolytic anemia occurring mainly in CLL patients. We report a case of immune hemolytic anemia that developed after exposure to bendamustine in a 70-year-old female with CLL who was previously exposed to fludarabine. Previous exposure to fludarabine is a common finding in the majority of reported cases of bendamustine drug-induced immune hemolytic anemia (DIIHA), including our case. Bendamustine should be suspected as the cause of any hemolytic anemia that develops while on this drug, especially in CLL patients treated previously with fludarabine.
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Affiliation(s)
- Housam Haddad
- Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, United States.
| | - Farhan Mohammad
- Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, United States.
| | - Qun Dai
- Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305, United States.
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8
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Takahashi H, Ohkawara H, Ikeda K, Harada-Shirado K, Furukawa M, Sukegawa M, Shichishima-Nakamura A, Noji H, Wakamatsu S, Tasaki K, Suzuki H, Ogawa K, Takeishi Y. Pleural solitary fibrous tumor complicated with autoimmune hemolytic anemia. Intern Med 2014; 53:1549-52. [PMID: 25030571 DOI: 10.2169/internalmedicine.53.2121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a 74-year-old woman who presented with autoimmune hemolytic anemia (AIHA) associated with pleural solitary fibrous tumor (SFT). Her AIHA was initially treated with 1 mg/kg daily of oral prednisolone (PSL) for 2 months, which had a limited effect. However, after surgical tumor resection, the patient showed remarkable improvement of AIHA with normalizations of serum lactate dehydrogenase and bilirubin levels, and we were able to rapidly reduce the PSL dosage. This is the first description of a case of AIHA caused by SFT.
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MESH Headings
- Administration, Oral
- Aged
- Anemia, Hemolytic, Autoimmune/diagnosis
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/etiology
- Diagnosis, Differential
- Dose-Response Relationship, Drug
- Female
- Glucocorticoids/administration & dosage
- Humans
- Prednisolone/administration & dosage
- Radiography, Thoracic
- Solitary Fibrous Tumor, Pleural/complications
- Solitary Fibrous Tumor, Pleural/diagnosis
- Solitary Fibrous Tumor, Pleural/surgery
- Thoracic Surgical Procedures/methods
- Tomography, X-Ray Computed
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Affiliation(s)
- Hiroshi Takahashi
- Department of Cardiology and Hematology, Fukushima Medical University, Japan
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9
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Short communication: bendamustine-related hemolytic anemia in chronic lymphocytic leukemia. Cancer Chemother Pharmacol 2013; 72:709-13. [PMID: 23907444 DOI: 10.1007/s00280-013-2243-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 07/22/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE Immune hemolytic anemia (IHA) may complicate the course of chronic lymphocytic leukemia (CLL), especially in patients with advanced disease, and as a complication of treatment with chlorambucil or fludarabine. Bendamustine, a novel agent with both alkylating and purine-analog properties, was approved in the USA for use in CLL in 2008. Since then, clinical data on its adverse events are accumulating. IHA related to bendamustine was seldom described and is thus reported and reviewed. METHODS We assessed five cases of CLL patients complicated by IHA, out of 31 treated with bendamustine for a relapse of their disease. Also reviewed are previous case reports in the literature. RESULTS AND CONCLUSIONS Bendamustine-related IHA is more common than suspected (16 %). No such cases were found in non-CLL patients. Personal history of fludarabine-triggered AIHA may be a risk factor for this complication (recorded in 4/5 patients, 80 %). The mechanism is thought to be related to the loss of T cell regulatory control as described for other agents. Physicians using bendamustine for the treatment for CLL should be aware of this complication.
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10
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D'Arena G, Guariglia R, La Rocca F, Trino S, Condelli V, De Martino L, De Feo V, Musto P. Autoimmune cytopenias in chronic lymphocytic leukemia. Clin Dev Immunol 2013; 2013:730131. [PMID: 23690826 PMCID: PMC3652131 DOI: 10.1155/2013/730131] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/18/2013] [Accepted: 03/22/2013] [Indexed: 11/25/2022]
Abstract
The clinical course of chronic lymphocytic leukemia (CLL) may be complicated at any time by autoimmune phenomena.The most common ones are hematologic disorders, such as autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP). Pure red cell aplasia (PRCA) and autoimmune agranulocytosis (AG) are, indeed, more rarely seen. However, they are probably underestimated due to the possible misleading presence of cytopenias secondary to leukemic bone marrow involvement or to chemotherapy cytotoxicity. The source of autoantibodies is still uncertain, despite the most convincing data are in favor of the involvement of resting normal B-cells. In general, excluding the specific treatment of underlying CLL, the managementof these complications is not different from that of idiopathic autoimmune cytopenias or of those associated to other causes. Among different therapeutic approaches, monoclonal antibody rituximab, given alone or in combination, has shown to be very effective.
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MESH Headings
- Agranulocytosis/complications
- Agranulocytosis/drug therapy
- Agranulocytosis/immunology
- Agranulocytosis/pathology
- Anemia, Hemolytic, Autoimmune/complications
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/immunology
- Anemia, Hemolytic, Autoimmune/pathology
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Autoantibodies/immunology
- Autoimmunity
- Humans
- Immunologic Factors/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Red-Cell Aplasia, Pure/complications
- Red-Cell Aplasia, Pure/drug therapy
- Red-Cell Aplasia, Pure/immunology
- Red-Cell Aplasia, Pure/pathology
- Rituximab
- Thrombocytopenia/complications
- Thrombocytopenia/drug therapy
- Thrombocytopenia/immunology
- Thrombocytopenia/pathology
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Affiliation(s)
- Giovanni D'Arena
- Onco-Hematology Department, IRCCS Centro di Riferimento Oncologico della Basilicata, 85028 Rionero in Vulture, Italy.
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11
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Laurenti L, Vannata B, Innocenti I, Autore F, Santini F, Sica S, Efremov DG. The use of monoclonal antibodies in the treatment of autoimmune complications of chronic lymphocytic leukemia. Mediterr J Hematol Infect Dis 2013; 5:e2013027. [PMID: 23667725 PMCID: PMC3647707 DOI: 10.4084/mjhid.2013.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/04/2013] [Indexed: 12/27/2022] Open
Abstract
Autoimmune cytopenias are a frequent complication in CLL, occurring in approximately 5-10% of the patients. The most common manifestation is autoimmune haemolytic anaemia, followed by immune thrombocytopenia and only rarely pure red blood cell aplasia or autoimmune granulocytopenia. Initial treatment is as for the idiopathic autoimmune cytopenias, with most patients responding to conventional corticosteroid therapy. Patients, who do not respond to conventional therapy after 4-6 weeks, should be considered for alternative immunosuppression, monoclonal antibody therapy or splenectomy. While randomized trials demonstrating the benefit of rituximab in CLL-related autoimmune diseases are still lacking, there are considerable data in the literature that provide evidence for its effectiveness. The monoclonal antibody alemtuzumab also displays considerable activity against both the malignant disease and the autoimmune complication in patients with CLL, although at the expense of greater toxicity. A number of new monoclonal antibodies, such as ofatumumab, GA-101, lumiliximab, TRU-016, epratuzumab, and galiximab, are currently investigated in CLL and their activity in CLL-related autoimmune cytopenias should be evaluated in future studies.
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Affiliation(s)
- Luca Laurenti
- Department of Hematology, Catholic University of Rome, “A. Gemelli” Hospital, Largo A. Gemelli 8, Rome, Italy
| | - Barbara Vannata
- Department of Hematology, Catholic University of Rome, “A. Gemelli” Hospital, Largo A. Gemelli 8, Rome, Italy
| | - Idanna Innocenti
- Department of Hematology, Catholic University of Rome, “A. Gemelli” Hospital, Largo A. Gemelli 8, Rome, Italy
| | - Francesco Autore
- Department of Hematology, Catholic University of Rome, “A. Gemelli” Hospital, Largo A. Gemelli 8, Rome, Italy
| | - Francesco Santini
- Department of Hematology, Catholic University of Rome, “A. Gemelli” Hospital, Largo A. Gemelli 8, Rome, Italy
| | - Simona Sica
- Department of Hematology, Catholic University of Rome, “A. Gemelli” Hospital, Largo A. Gemelli 8, Rome, Italy
| | - Dimitar G. Efremov
- Department of Molecular Hematology, International Centre for Genetic Engineering & Biotechnology, Campus A. Buzzati-Traverso, Rome, Italy
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12
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Hodgson K, Ferrer G, Montserrat E, Moreno C. Chronic lymphocytic leukemia and autoimmunity: a systematic review. Haematologica 2011; 96:752-61. [PMID: 21242190 PMCID: PMC3084923 DOI: 10.3324/haematol.2010.036152] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 12/15/2010] [Accepted: 01/11/2011] [Indexed: 11/09/2022] Open
Abstract
Chronic lymphocytic leukemia is frequently associated with immune disturbances. The relationship between chronic lymphocytic leukemia and autoimmune cytopenias, particularly autoimmune hemolytic anemia and immune thrombocytopenia, is well established. The responsible mechanisms, particularly the role of leukemic cells in orchestrating the production of polyclonal autoantibodies, are increasingly well understood. Recent studies show that autoimmune cytopenia is not necessarily associated with poor prognosis. On the contrary, patients with anemia or thrombocytopenia due to immune mechanisms have a better outcome than those in whom these features are due to bone marrow infiltration by the disease. Moreover, fears about the risk of autoimmune hemolysis following single agent fludarabine may no longer be appropriate in the age of chemo-immunotherapy regimens. However, treatment of patients with active hemolysis may pose important problems needing an individualized and clinically sound approach. The concept that autoimmune cytopenia may precede the leukemia should be revisited in the light of recent data showing that autoimmune cytopenia may be observed in monoclonal B-cell lymphocytosis, a condition that can only be detected by using sensitive flow cytometry techniques. On the other hand, there is no evidence of an increased risk of non-hemic autoimmune disorders in chronic lymphocytic leukemia. Likewise, there is no epidemiological proof of an increased risk of chronic lymphocytic leukemia in patients with non-hemic autoimmunity. Finally, since immune disorders are an important part of chronic lymphocytic leukemia, studies aimed at revealing the mechanisms linking the neoplastic and the immune components of the disease should help our understanding of this form of leukemia.
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Affiliation(s)
- Kate Hodgson
- Institute of Hematology and Oncology, Department of Hematology, Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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13
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Hodgson K, Ferrer G, Pereira A, Moreno C, Montserrat E. Autoimmune cytopenia in chronic lymphocytic leukaemia: diagnosis and treatment. Br J Haematol 2011; 154:14-22. [DOI: 10.1111/j.1365-2141.2011.08707.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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IGHV gene rearrangements as outcome predictors for CLL patients: experience of Ukrainian group. Med Oncol 2011; 29:1093-101. [PMID: 21503826 DOI: 10.1007/s12032-011-9872-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 02/17/2011] [Indexed: 12/15/2022]
Abstract
Important characteristics of chronic lymphocytic leukaemia (CLL) cells are biased immunoglobulin variable heavy chain (IGHV) gene repertoire and expression of stereotyped B-cell receptors (BCRs); however, their prognostic value (in contrast to the impact of IGHV gene mutational status) is less clear. To evaluate the impact of separate IGHV gene usage and expression of stereotyped BCRs in CLL prognosis. Clinical data and IGHV gene configuration were analysed in 319 consecutive patients with CLL. We found that the majority of clinical parameters of patients were defined by IGHV mutational status. Our data also provided new evidence supporting the prognostic relevance of separate IGHV genes or stereotyped BCR in CLL, namely: (a) a restricted non-mutated (UM) IGHV gene repertoire in CLL patients with autoimmune haemolytic anaemia (AIHA) (more frequent expression of UM IGHV1-69, IGHV3-11 and IGHV4-59 genes, P = 0.001), a shorter period of AIHA development for expressors of these genes (P = 0.001) and a tendency towards expression of a stereotypic HCDR3 (P = 0.029), (b) a high incidence of second solid tumour development in IGHV3-21-expressing patients (P = 0.005) and (c) differences in overall survival (OS) of UM CLL patients depending on the BCR structure. Further research of specific IGHV gene usage and subsets of stereotyped BCRs in CLL may be helpful in more precise prediction of CLL prognosis in individual patients.
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15
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Xu W, Li JY, Miao KR, Cao X, Liu Q, Fan L, Qiao C, Wu YJ. The negative prognostic significance of positive direct antiglobulin test in Chinese patients with chronic lymphocytic leukemia. Leuk Lymphoma 2011; 50:1482-7. [PMID: 19606377 DOI: 10.1080/10428190903111930] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Chronic lymphocytic leukemia (CLL) is the most common type of adult leukemia in the Western countries, however, it is infrequent in the Eastern countries. The direct antiglobulin test (DAT) may be positive at some time during the disease course of CLL. The aim of this study was to explore the prognostic impact of positive DAT at diagnosis in Chinese patients with CLL. In 123 Chinese patients with CLL, 34 (27.6%) patients presented with a positive DAT at diagnosis. However only 12 patients (9.8%) with a positive DAT developed autoimmune hemolytic anemia (AHA). According to the correlation analysis, advanced Binet stage (p < 0.001), high level of serum lactate dehydrogenase (LDH) (p = 0.003) and beta(2)-microglobulin (beta(2)-M) (p = 0.011), unmutated immunoglobulin heavy chain variable gene status (p < 0.001), positive ZAP-70 (p = 0.012), and trisomy 12 cytogenetic aberration (p = 0.004) emerged as factors significantly related to the occurrence of DAT-positive. Patients with positive DAT had significantly shorter survival times than patients with negative DAT (p = 0.009). Five-year OS percentages of DAT-positivity and DAT-negative patients were 72.8% and 97.5%, respectively. It was showed that DAT status might be applied for the assessment of prognosis in patients with CLL.
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Affiliation(s)
- Wei Xu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
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16
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D’Arena G, Capalbo S, Laurenti L, Del Poeta G, Nunziata G, Deaglio S, Spinosa G, Tarnani M, De Padua L, Califano C, Ferrara F, Cascavilla N. Chronic lymphocytic leukemia-associated immune thrombocytopenia treated with rituximab: a retrospective study of 21 patients. Eur J Haematol 2010; 85:502-7. [DOI: 10.1111/j.1600-0609.2010.01527.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Smolej L, Belada D, Cermanová M, Maisnar V, Lunáková E. Severe anemia caused by combination of autoimmune hemolysis, pure red cell aplasia and massive bone marrow infiltration in an elderly patient with chronic lymphocytic leukemia: successful treatment with rituximab. Leuk Res 2010; 34:e140-1. [PMID: 20053448 DOI: 10.1016/j.leukres.2009.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 11/14/2009] [Accepted: 11/15/2009] [Indexed: 11/16/2022]
MESH Headings
- Aged
- Anemia, Hemolytic/complications
- Anemia, Hemolytic/drug therapy
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Autoimmune Diseases/complications
- Autoimmune Diseases/drug therapy
- Chlorambucil/therapeutic use
- Cyclophosphamide/therapeutic use
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/physiopathology
- Male
- Prednisone/therapeutic use
- Red-Cell Aplasia, Pure/complications
- Red-Cell Aplasia, Pure/drug therapy
- Rituximab
- Salvage Therapy/methods
- Vincristine/therapeutic use
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18
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Glance LE, Cumpston A, Kanate A, Remick SC. Bendamustine-Associated Hemolytic Anemia. Ann Pharmacother 2009; 43:1903-6. [PMID: 19809007 DOI: 10.1345/aph.1m329] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective: To report a case of probable bendamustine-related hemolytic anemia. Case Summary: A 64-year-old white female had recently received treatment with bendamustine for stage III follicular lymphoma. After her fourth cycle, she was admitted to an outside facility with severe right upper quadrant pain across her back and findings consistent with obstructive jaundice. She was found to have pancytopenia and elevations in total bilirubin, alkaline phosphatase, and transaminase levels. A bone marrow biopsy showed no evidence of lymphoma and presence of megakaryocytes on 2 occasions. Upon transfer to West Virginia University Hospitals, her haptoglobin was found to be undetectable, total bilirubin 10.3 mg/dL (unconjugated bilirubin 4.9 mg/dL), reticulocyte count 21.4% (reticulocyte index ≥2%), alkaline phosphatase 1125 U/L, and lactate dehydrogenase 421 U/L. The peripheral smear showed evidence of spherocytes and very rare schistocytes. Based on these findings, the woman was diagnosed with hemolytic anemia secondary to bendamustine exposure. She was started on prednisone 1 mg/kg (60 mg) daily and, soon after, her platelets and hemoglobin stabilized. Discussion: Drug-induced hemolytic anemia is an acquired or extrinsic process that results in antibody-mediated red blood cell destruction. The patient was not taking any medications commonly associated with hemolytic anemia; however, her laboratory test results were consistent with hemolytic anemia. Based on bendamustine's structural similarity to fludarabine and fludarabine s association with causing hemolytic anemia, we considered exposure to bendamustine to be the most likely contributory factor for her diagnosis. According to the Naranjo probability scale, a probable likelihood was reflected in bendamustine causing the hemolytic anemia. Conclusions: Continued monitoring of postmarketing data is necessary to correlate this occurrence of hemolytic anemia with bendamustine therapy.
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Affiliation(s)
- Lisa E Glance
- West Virginia University Pharmaceutical Services, West Virginia University Hospitals, Morgantown, WV
| | - Aaron Cumpston
- West Virginia University Pharmaceutical Services, West Virginia University Hospitals
| | - Abraham Kanate
- West Virginia University Section of Hematology/Oncology, School of Medicine, West Virginia University
| | - Scot C Remick
- West Virginia University Section of Hematology/Oncology, Mary Babb Randolph Cancer Center, School of Medicine, West Virginia University
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19
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Dong Y, Na J, Lv J, Wang R, Chen X, Li N, Ren H. Clinical and laboratory characterization of a large cohort of patients with Castleman disease retrospectively collected from a single center. Leuk Lymphoma 2009; 50:1308-17. [DOI: 10.1080/10428190903060095] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Abstract
There is a major evolution in progress in the first-line therapy of chronic lymphocytic leukaemia. Several recent, large, clinical trials have documented superior outcomes with fludarabine-based therapy compared with treatment with alkylating agents. Monoclonal antibodies, especially rituximab, are establishing an important role for targeted treatment. It is expected that chemoimmunotherapy will become the preferred treatment for many patients in the near future. Specific challenges remain to be answered, however, especially the optimal treatment for the elderly, patients with autoimmune haemolysis and those with P53 deletions and mutations.
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Affiliation(s)
- D A Carney
- Peter MacCallum Cancer Centre, East Melbourne, Melbourne, Victoria, Australia
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D'Arena G, Cascavilla N. Chronic Lymphocytic Leukemia-Associated Pure Red Cell Aplasia. Int J Immunopathol Pharmacol 2009; 22:279-86. [DOI: 10.1177/039463200902200204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pure red cell aplasia (PRCA) is a well-known marrow failure which may be acquired or constitutional/congenital, as the Diamond-Blackfan syndrome. Acquired PRCA may show as a primary hematological disorder or secondary to an associated disease, infection or drug. PRCA rarely complicates chronic lymphocytic leukemia (CLL), may occur anytime in the course of the disease and, in this context, it is a minority of total PRCA. Anemia due to PRCA in CLL patients must be carefully evaluated and differentiated from other causes (autoimmune hemolytic anemia, neoplastic lymphocyte infiltration of bone marrow, chemotherapy) that require a different therapeutic approach. PRCA is thought to be an immunologically mediated disorder, but there is no uniformity in the setting of the management. Immunosuppressive therapy is frequently given, such as steroids and cyclosporin-A. Recently, anecdotal cases have been published on the effectiveness of monoclonal antibodies rituximab and alemtuzumab.
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Affiliation(s)
- G. D'Arena
- Hematology and Stem Cell Transplantation Unit, IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, Italy
| | - N. Cascavilla
- Hematology and Stem Cell Transplantation Unit, IRCCS “Casa Sollievo della Sofferenza” Hospital, San Giovanni Rotondo, Italy
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Castillo J, Milani C, Mendez-Allwood D. Ofatumumab, a second-generation anti-CD20 monoclonal antibody, for the treatment of lymphoproliferative and autoimmune disorders. Expert Opin Investig Drugs 2009; 18:491-500. [DOI: 10.1517/13543780902832679] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jorge Castillo
- The Miriam Hospital, Division of Hematology and Oncology, 164 Summit Ave, Fain Building, Providence, RI 02906, USA ;
| | - Cannon Milani
- The Miriam Hospital, Division of Hematology and Oncology, 164 Summit Ave, Fain Building, Providence, RI 02906, USA ;
| | - Daniel Mendez-Allwood
- Boston University School of Medicine, Roger Williams Medical Center, Department of Medicine, Providence, RI, USA
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D’Arena G, Vigliotti ML, Dell’Olio M, Villa MR, Mantuano S, Scalzulli PR, La Sala A, Abbadessa A, Mastrullo L, Cascavilla N. Rituximab to treat chronic lymphoproliferative disorder-associated pure red cell aplasia. Eur J Haematol 2009; 82:235-9. [DOI: 10.1111/j.1600-0609.2008.01187.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Autoimmune pancreatitis and concurrent small lymphocytic lymphoma: not just a coincidence? J Gastrointest Surg 2008; 12:1566-70. [PMID: 18506547 DOI: 10.1007/s11605-008-0543-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 05/02/2008] [Indexed: 01/31/2023]
Abstract
CASE A 76-year-old gentleman presented with painless jaundice, weight loss, and anorexia. Computed tomography imaging revealed fullness of the pancreatic head and multiple enlarged retroperitoneal lymph nodes. Cholangiogram revealed a distal common bile duct stricture. Due to concerns of malignancy, the patient underwent operative exploration. Several enlarged lymph nodes in the aortocaval region and a firm hard mass in the pancreatic head were found. Frozen section from one of the lymph nodes was suspicious for low-grade lymphoma. A pancreaticoduodenectomy was performed. Histologic analysis of the pancreatic head revealed a lymphoplasmacytic infiltrate with stromal fibrosis consistent with autoimmune pancreatitis. The retroperitoneal lymph nodes were involved by small lymphocytic lymphoma. DISCUSSION Autoimmune pancreatitis is the most common benign diagnosis after pancreatic resection for presumed malignancy. It has a well-documented association with autoimmune conditions, such as Sjögren's syndrome, inflammatory bowel disease, and sclerosing cholangitis. Additionally, chronic lymphocytic leukemia-small lymphocytic lymphoma is often associated with autoimmune phenomena, most notably autoimmune hemolytic anemia. However, an association between autoimmune pancreatitis and small lymphocytic lymphoma has not been previously described. To our knowledge, this is the first reported case of a patient with concurrent autoimmune pancreatitis and small lymphocytic lymphoma.
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Dasanu CA. Intrinsic and treatment-related immune alterations in chronic lymphocytic leukaemia and their impact for clinical practice. Expert Opin Pharmacother 2008; 9:1481-94. [PMID: 18518779 DOI: 10.1517/14656566.9.9.1481] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Chronic lymphocytic leukaemia patients harbour important impairments in both their cellular- and humoral-mediated immunity, which accounts for their notorious susceptibility to a multitude of infections and various autoimmune cytopenias. It has also been shown that the rate of second cancers is increased in chronic lymphocytic leukaemia. OBJECTIVE The aim of this study was to review the immune alterations in untreated and treated chronic lymphocytic leukaemia and define their impact for clinical practice. METHODS The author gives a comprehensive review of the most relevant preclinical and clinical studies pertaining to various immune abnormalities and infectious complications in both untreated and treated chronic lymphocytic leukaemia. Landmark clinical trials involving the contemporary chronic lymphocytic leukaemia chemo- and immunotherapies, alone or in combination, as well as the main epidemiological studies establishing the increased rate of second cancers in chronic lymphocytic leukaemia are also discussed. RESULTS/CONCLUSIONS Iatrogenic immunosuppression in chronic lymphocytic leukaemia alters the pattern of opportunistic infections, can cause autoimmune cytopenias and might further increase the rate of second malignancies in patients whose disease already places them at a greater risk. Careful consideration of existing risk factors in chronic lymphocytic leukaemia could establish the optimal screening and follow-up schedule for chronic lymphocytic leukaemia patients as its therapeutics evolves.
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Affiliation(s)
- Constantin A Dasanu
- Seattle Hematology-Oncology, 2202 70th Ave West, University Place, WA 98466, USA.
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Gentile M, Lucia E, Iorio C, Vigna E, Mazzone C, Morelli R, Bisconte MG, Gentile C, Morabito F. Prompt and sustained response of a steroid-refractory autoimmune hemolytic anemia to a rituximab-based therapy in a chronic lymphocytic leukemia patient. Cancer Chemother Pharmacol 2007; 62:741-3. [PMID: 18064461 DOI: 10.1007/s00280-007-0651-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2007] [Accepted: 11/20/2007] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Autoimmune hemolytic anemia (AIHA) is a rare and potentially life-threatening event which may complicate the course of chronic lymphocytic leukemia (CLL) at any time and steroid-refractory AIHA of CLL poses a therapeutic challenge for physicians. Here, we report the safety and efficacy of a rituximab-containing regimen in a CLL patient with steroid- and IVIg-refractory AIHA. CASE REPORT A 57-year- old man affected by CLL, presented with fatigue, dyspnoea, tachycardia and jaundice. His physical examination revealed overt jaundice, hepato- and splenomegaly, and enlargement of lymph nodes in all superficial sites. The blood chemistry showed severe anemia (Hb value 3.9 g/dL), high white blood cell count (89 x 10(9)/L), altered hemolysis markers and direct antiglobulin test (DAT) was positive for both complement and IgG. The patient failed to respond to both a 4-day course of high-dose dexamethasone IV (40 mg/day) and intravenous immunoglobulin (IVIg) (1 g/kg/day x 2 days). Thus, a schedule containing rituximab (375 mg/m(2) day +1), cyclophosphamide (750 mg/m(2) day +2) and prednisone (60 mg/m(2) from day +1 to day +7) (R-CP) were administered. Four cycles, repeated every 4 weeks, were administered. After 4 days from the infusion of this schedule, the patient showed a marked reduction of the lymphocytosis, and the hemoglobin level started to increase. No rituximab-related side effects were recorded. At the end of treatment DAT became negative and patient achieved a nodular Partial Remission (nPR). CONCLUSION Our data showed the safety and efficacy of a rituximab-containing regimen in a life-threatening CLL-related AIHA, refractory to steroid and IVIg therapy. This schedule has allowed the patient to obtain a prompt and dramatic rise in hemoglobin level and a response to both AIHA and CLL.
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MESH Headings
- Anemia, Hemolytic, Autoimmune/drug therapy
- Anemia, Hemolytic, Autoimmune/etiology
- Anemia, Hemolytic, Autoimmune/pathology
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Glucocorticoids/therapeutic use
- Humans
- Immunoglobulins, Intravenous/therapeutic use
- Immunologic Factors/therapeutic use
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Male
- Middle Aged
- Rituximab
- Treatment Failure
- Treatment Outcome
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Affiliation(s)
- Massimo Gentile
- Hematology Unit, Dipartimento di Medicina Interna, Azienda Ospedaliera di Cosenza, Via Migliori, 87100, Cosenza, Italy.
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