1
|
Langerbeins P, Giza A, Robrecht S, Cramer P, von Tresckow J, Al-Sawaf O, Fink AM, Fürstenau M, Kater AP, van der Spek E, Niemann CU, da Cunha-Bang C, Tausch E, Schneider C, Stilgenbauer S, Fischer K, Hallek M, Eichhorst B. Infections in patients with chronic lymphocytic leukemia treated with time limited targeted drug combinations. Am J Hematol 2024; 99:1620-1623. [PMID: 38757754 DOI: 10.1002/ajh.27367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/16/2024] [Accepted: 04/26/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Petra Langerbeins
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Adam Giza
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Sandra Robrecht
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Paula Cramer
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Julia von Tresckow
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University of Duisburg-Essen, Essen, Germany
| | - Othman Al-Sawaf
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anna Maria Fink
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Moritz Fürstenau
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Ellen van der Spek
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, Netherlands
| | | | | | - Eugen Tausch
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Christof Schneider
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Stephan Stilgenbauer
- Department of Internal Medicine III, Division of CLL, University Hospital Ulm, Ulm, Germany
| | - Kirsten Fischer
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael Hallek
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Barbara Eichhorst
- Department I of Internal Medicine and German CLL Study Group, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| |
Collapse
|
2
|
Murru R, Galitzia A, Barabino L, Presicci R, La Nasa G, Caocci G. Prediction of severe infections in chronic lymphocytic leukemia: a simple risk score to stratify patients at diagnosis. Ann Hematol 2024; 103:1655-1664. [PMID: 38236391 PMCID: PMC11009768 DOI: 10.1007/s00277-024-05625-y] [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: 09/12/2023] [Accepted: 01/11/2024] [Indexed: 01/19/2024]
Abstract
Chronic Lymphocytic Leukemia (CLL) is well-known for increasing susceptibility to infections. Factors such as immune dysregulation, IGHV status, hypogammaglobulinemia, and patient comorbidity and treatment, contribute to higher infection rates and mortality. However, the impact of hypogammaglobulinemia on infection rates is controversial. We aimed to identify clinical and biological parameters linked to the risk of severe infectious events. Additionally, we set up a straightforward risk infection score to stratify CLL patients at diagnosis, thereby enabling the development of suitable infection prevention strategies. We retrospectively evaluated 210 unselected CLL patients diagnosed between 1988 and 2018. This evaluation encompassed demographics, Binet stage, immunoglobulin (Ig) levels, treatment history, comorbidities, and IGHV mutational status at diagnosis. The frequency and severity of infectious events were recorded. Analysis revealed that age, IGHV mutational status, Binet stage, and hypogammaglobulinemia were statistically associated with the Time to First Infection (TTFI) in univariate and multivariate analyses. Using hazard ratios from the multivariate analysis, we finally devised a risk scoring system that integrated age, IGHV mutational status, immunoglobulin levels, and Binet stage to stratify patients at diagnosis based on their specific infection risk. In our cohort, disease progression and infections were the leading cause of death. These findings pointed out the clinical need for a screening process strategic for defining infectious risk at the time of CLL diagnosis, with a significant enhancement in the clinical management of these patients.
Collapse
Affiliation(s)
- Roberta Murru
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS G. Brotzu, Cagliari, Italy
| | - Andrea Galitzia
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Luca Barabino
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Roberta Presicci
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giorgio La Nasa
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS G. Brotzu, Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giovanni Caocci
- Hematology and Stem Cell Transplantation Unit, Ospedale Oncologico A. Businco, ARNAS G. Brotzu, Cagliari, Italy.
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| |
Collapse
|
3
|
Svanberg Teglgaard R, Marquart HV, Hartling HJ, Bay JT, da Cunha-Bang C, Brieghel C, Faitová T, Enggaard L, Kater AP, Levin MD, Kersting S, Ostrowski SR, Niemann CU. Improved Innate Immune Function in Patients with Chronic Lymphocytic Leukemia Treated with Targeted Therapy in Clinical Trials. Clin Cancer Res 2024; 30:1959-1971. [PMID: 38393694 DOI: 10.1158/1078-0432.ccr-23-2522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/06/2023] [Accepted: 02/21/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Patients with chronic lymphocytic leukemia (CLL) have increased risk of severe infections. Although adaptive immune dysfunction is well described, clinical tools for identifying patients at risk are lacking, warranting investigation of additional immune components. In contrast to chemotherapy, targeted agents could spare or even improve innate immune function. Therefore, we investigated innate immune phenotypes and function in patients with CLL before and during targeted treatment. EXPERIMENTAL DESIGN Baseline and consecutive blood samples were collected from patients with CLL treated with acalabrutinib (n = 17) or ibrutinib+venetoclax (n = 18) in clinical trials. Innate immune function was assessed by TruCulture, a whole-blood ligand-stimulation assay quantifying cytokine release in response to standardized stimuli. Innate immune phenotypes were characterized by flow cytometry. As a proxy for infections, we mapped antimicrobial use before and during treatment. RESULTS At baseline, patients with CLL displayed impaired stimulated cytokine responses to the endotoxin lipopolysaccharide (LPS) along with deactivated monocytes, enrichment of myeloid-derived suppressor cells and metamyelocytes, and elevated (unstimulated) proinflammatory cytokines. Two/three cycles of acalabrutinib or ibrutinib normalized LPS-stimulated responses, in parallel with decreased duration of infections. Innate immune profiles and elevated proinflammatory cytokines further normalized during longer-term acalabrutinib or ibrutinib+venetoclax, paralleled by decreased infection frequency. CONCLUSIONS Innate immune impairment and infection susceptibility in patients with CLL were restored in parallel during targeted therapy. Thus, targeted treatment may reduce the risk of infections in CLL, as currently under investigation in the PreVent-ACaLL phase 2 trial of acalabrutinib+venetoclax for high-risk CLL (NCT03868722).
Collapse
Affiliation(s)
| | | | | | - Jakob Thaning Bay
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | | | | | - Tereza Faitová
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
| | | | - Arnon P Kater
- Department of Hematology, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Cancer Center Amsterdam, Lymphoma and Myeloma Center Amsterdam, Amsterdam, the Netherlands
| | - Mark-David Levin
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - Sabina Kersting
- Department of Hematology, Haga Ziekenhuis, Den Haag, the Netherlands
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carsten U Niemann
- Department of Hematology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
McQuilten ZK, Weinkove R, Thao LTP, Crispin P, Degelia A, Dendle C, Gilbertson M, Johnston A, Keegan A, Pepperell D, Pullon H, Reynolds J, van Tonder T, Trotman J, Waters N, Wellard C, Weston H, Morrissey CO, Wood EM. Immunoglobulin replacement vs prophylactic antibiotics for hypogammaglobulinemia secondary to hematological malignancy. Blood Adv 2024; 8:1787-1795. [PMID: 38592710 PMCID: PMC11006812 DOI: 10.1182/bloodadvances.2023011231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/20/2023] [Indexed: 04/10/2024] Open
Abstract
ABSTRACT Immunoglobulin replacement and prophylactic antibiotics are commonly used to prevent infections in patients with secondary hypogammaglobulinemia due to hematological malignancies but have never been directly compared. In this randomized controlled feasibility trial conducted in 7 hospitals in Australia and New Zealand, we enrolled patients with secondary hypogammaglobulinemia with either a history of recurrent/severe infection or an immunoglobulin G level <4 g/L. Participants were randomized in a 1:2 ratio to immunoglobulin (0.4 g/kg per 4 weeks IV) or daily antibiotics (trimethoprim-sulfamethoxazole 160 mg/800 mg or, if contraindicated, 100 mg doxycycline) for 12 months. Participants allocated to antibiotics were allowed to crossover after grade ≥3 infections. The primary outcome was proportion of patients alive on the assigned treatment 12 months after randomization. Between August 2017 and April 2019, 63 patients were randomized: 42 to antibiotics and 21 to immunoglobulin. Proportion of participants alive on allocated treatment at 12 months was 76% in the immunoglobulin and 71% in the antibiotic arm (Fisher exact test P=.77; odds ratio, 0.78; 95% CI, 0.22-2.52). The lower quartile for time to first major infection (median, not reached) was 11.1 months for the immunoglobulin and 9.7 months for the antibiotic arm (log-rank test, P=.65). Three participants in the immunoglobulin and 2 in the antibiotic arm had grade ≥3 treatment-related adverse events. A similar proportion of participants remained on antibiotic prophylaxis at 12 months to those on immunoglobulin, with similar rates of major infections. Our findings support the feasibility of progressing to a phase 3 trial. Trial registration #ACTRN12616001723471.
Collapse
Affiliation(s)
- Zoe K. McQuilten
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Haematology, Monash Health, Melbourne, Australia
| | - Robert Weinkove
- Te Rerenga Ora Wellington Blood & Cancer Centre, Te Whatu Ora Health New Zealand Capital, Coast & Hutt Valley, Wellington, New Zealand
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
- Department of Pathology & Molecular Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Le Thi Phuong Thao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Philip Crispin
- Department of Haematology, Canberra Hospital, Canberra, Australia
| | - Amber Degelia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Claire Dendle
- Monash Infectious Diseases, Monash Health, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
| | | | - Anna Johnston
- Department of Haematology, Royal Hobart Hospital, Hobart, Australia
- Department of Medicine, University of Tasmania, Hobart, Australia
| | - Anastazia Keegan
- PathWest Laboratory Medicine, King Edward Memorial Hospital, Perth, Australia
| | | | - Humphrey Pullon
- Department of Haematology, Waikato Hospital, Hamilton, New Zealand
| | - John Reynolds
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Tina van Tonder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Judith Trotman
- Department of Haematology, Concord Repatriation General Hospital, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
| | - Neil Waters
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Helen Weston
- Department of Haematology, Sunshine Coast University Hospital, Sunshine Coast, Australia
| | - C. Orla Morrissey
- Central Clinical School, Monash University, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health, Melbourne, Australia
| | - Erica M. Wood
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Haematology, Monash Health, Melbourne, Australia
| | - Australasian Leukaemia and Lymphoma Group
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Haematology, Monash Health, Melbourne, Australia
- Te Rerenga Ora Wellington Blood & Cancer Centre, Te Whatu Ora Health New Zealand Capital, Coast & Hutt Valley, Wellington, New Zealand
- Cancer Immunotherapy Programme, Malaghan Institute of Medical Research, Wellington, New Zealand
- Department of Pathology & Molecular Medicine, University of Otago Wellington, Wellington, New Zealand
- Department of Haematology, Canberra Hospital, Canberra, Australia
- Monash Infectious Diseases, Monash Health, Melbourne, Australia
- School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Haematology, Royal Hobart Hospital, Hobart, Australia
- Department of Medicine, University of Tasmania, Hobart, Australia
- PathWest Laboratory Medicine, King Edward Memorial Hospital, Perth, Australia
- Department of Haematology, Fiona Stanley Hospital, Perth, Australia
- Department of Haematology, Waikato Hospital, Hamilton, New Zealand
- Central Clinical School, Monash University, Melbourne, Australia
- Department of Haematology, Concord Repatriation General Hospital, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
- Department of Haematology, Sunshine Coast University Hospital, Sunshine Coast, Australia
- Department of Infectious Diseases, Alfred Health, Melbourne, Australia
| |
Collapse
|
5
|
Kislova M, Petrenko A, Dmitrieva EA, Milenkin A, Nikitin KE, Ptushkin VV, Shabunin AV, Nikitin EA. Significant reduction in the incidence of non-coronavirus infections in patients with chronic lymphocytic leukemia on ibrutinib and venetoclax treatment during the COVID-19 pandemic: An additional benefit of lockdown. Hematol Oncol 2023; 41:683-693. [PMID: 37058711 DOI: 10.1002/hon.3156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/08/2023] [Accepted: 04/08/2023] [Indexed: 04/16/2023]
Abstract
Effective treatment and prevention of infections challenge management of patients with chronic lymphicytic leukemia (CLL). The COVID-19 pandemic resulted in the reduction of outpatient hospital visits as a part of non-pharmaceutical interventions that could affect the incidence of infectious complications. Study enrolled patients with CLL receiving ibrutinib or/and venetoclax who were observed at the Moscow City Centre of Hematology from 01 April 2017 to 31 March 2021. We found a reduction in the incidence of infectious episodes after the implementation of the lockdown in Moscow in 01 April 2020, when compared to data on the year prior to the lockdown (p < 0.0001), as well as when compared to the predictive model (p = 0.02), and based on individual infection profiles using cumulative sums (p < 0.0001). Bacterial infections had 4.44-fold decrease, bacterial in combination with undefined infections had 4.89-fold decrease, viral infections had unsignificant changes. The decrease in the number of outpatient visits coincides with the time of the lockdown could be a likely factor, explaining a decline in the incidence of infection. Patients were clustered according incidence and severity of infectious episodes for subgroup mortality assessment. No differences in overall survival due to COVID-19 were observed. Typical respiratory infections, bacterial and undefined, the transmission of which may be affected by patient-to-patient contact in the settings of out-patient health care visits were decreased, possibly due to SARS-CoV-2 restrictive measures. A positive correlation between outpatient visits and the incidence of bronchial and upper respiratory tract infection points at the role of hospital-acquired infection and attests to the necessity of reorganizing care for all patients with CLL.
Collapse
Affiliation(s)
| | - Andrei Petrenko
- Botkin Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Medical Education, Moscow, Russia
| | | | | | | | - Vadim V Ptushkin
- Botkin Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Medical Education, Moscow, Russia
| | - Alexey V Shabunin
- Botkin Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Medical Education, Moscow, Russia
| | - Eugene A Nikitin
- Botkin Hospital, Moscow, Russia
- Russian Medical Academy of Continuous Medical Education, Moscow, Russia
| |
Collapse
|
6
|
Alshemmari SH, Alsarraf A, Kunhikrishnan A, Pandita R. Evaluation of the CLL-IPI and IPS-E Prognostic Indices in a Young Middle Eastern Population with Chronic Lymphocytic Leukemia: A Retrospective Analysis at the Kuwait Cancer Control Center. Med Princ Pract 2023; 32:192-199. [PMID: 37517397 PMCID: PMC10601689 DOI: 10.1159/000533284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/23/2023] [Indexed: 08/01/2023] Open
Abstract
INTRODUCTION The Chronic Lymphocytic Leukemia International Prognostic Index (CLL-IPI) is a powerful prognostic tool validated in multiple Western populations. However, its utility in the young Middle Eastern population is unknown. METHODOLOGY We conducted a retrospective analysis of 152 unselected patients with chronic lymphocytic leukemia (CLL) diagnosed between 2008 and 2022 at the Kuwait Cancer Control Center, which serves as the sole cancer center in Kuwait. The evaluation of the CLL-IPI was based on the assessment of event-free survival (EFS) across the entire cohort. Subsequently, we compared the CLL-IPI with the International Prognostic Score for Early-stage patients (IPS-E) in order to predict the time to first treatment specifically within the subgroup of patients diagnosed with early-stage disease. RESULTS The median age of the study cohort was 59.9 years (IQR, 53.1-68.8). The 5-year EFS rates for the low, intermediate, and high/very high-risk categories were approximately 82%, 34%, and 23%, respectively, p < 0.001 (C-statistic = 0.67). On multivariate analysis, advanced stage and unmated IGHV status were independent prognostic factors of EFS. In those with early-stage disease, cumulative 5-year treatment incidence rates for the low, intermediate, and high/very high-risk categories based on the CLL-IPI score were approximately 8%, 55%, and 55%, respectively, p = 0.001 (C-statistic = 0.70). However, based on the IPS-E score, the cumulative 5-year treatment incidence rates for the low, intermediate, and high-risk categories were approximately 0%, 10%, and 60%, respectively, p < 0.001 (C-statistic = 0.73). CONCLUSIONS The CLL-IPI and the IPS-E are valid stratification tool in our young Middle Eastern population.
Collapse
Affiliation(s)
- Salem H Alshemmari
- Department of Medicine, Kuwait University, Jabriya, Kuwait
- Department of Hematology, Kuwait Cancer Center, Shuwaikh, Kuwait
| | - Ahmad Alsarraf
- Department of Hematology, Kuwait Cancer Center, Shuwaikh, Kuwait
| | | | - Ramesh Pandita
- Department of Hematology, Kuwait Cancer Center, Shuwaikh, Kuwait
| |
Collapse
|
7
|
Liu Y, Song Y, Yin Q. Effects of ibrutinib on T-cell immunity in patients with chronic lymphocytic leukemia. Front Immunol 2022; 13:962552. [PMID: 36059445 PMCID: PMC9437578 DOI: 10.3389/fimmu.2022.962552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/28/2022] [Indexed: 12/15/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL), a highly heterogeneous B-cell malignancy, is characterized by tumor microenvironment disorder and T-cell immune dysfunction, which play a major role in the proliferation and survival of CLL cells. Ibrutinib is the first irreversible inhibitor of Bruton’s tyrosine kinase (BTK). In addition to targeting B-cell receptor (BCR) signaling to kill tumor cells, increasing evidence has suggested that ibrutinib regulates the tumor microenvironment and T-cell immunity in a direct and indirect manner. For example, ibrutinib not only reverses the tumor microenvironment by blocking cytokine networks and toll-like receptor signaling but also regulates T cells in number, subset distribution, T-cell receptor (TCR) repertoire and immune function by inhibiting interleukin-2 inducible T-cell kinase (ITK) and reducing the expression of inhibitory receptors, and so on. In this review, we summarize the current evidence for the effects of ibrutinib on the tumor microenvironment and cellular immunity of patients with CLL, particularly for the behavior and function of T cells, explore its potential mechanisms, and provide a basis for the clinical benefits of long-term ibrutinib treatment and combined therapy based on T-cell-based immunotherapies.
Collapse
|
8
|
Keegan A, Dennington PM, Dhondy N, Mulligan SP. Immunoglobulin replacement therapy in chronic lymphocytic leukaemia patients with hypogammaglobulinaemia and infection. Eur J Haematol 2022; 108:460-468. [PMID: 35152500 DOI: 10.1111/ejh.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyse total national utilisation of immunoglobulin (Ig) replacement therapy (IgRT) for Chronic Lymphocytic Leukaemia patients with acquired hypogammaglobulinaemia and severe and/or recurrent bacterial infections. METHODS In 2007, the National Blood Authority first published Criteria for the clinical use of intravenous immunoglobulin in Australia. The Australian Red Cross Lifeblood assessed, approved, and recorded all supply with patient demographics, distribution data, intravenous Ig (IVIg) volumes and treatment episodes. IVIg was the sole product used in Australia from 2008-2013 inclusive. RESULTS From 2008 to 2013 across Australia, 2734 individual CLL patients received 48,870 treatment episodes using a total 1,324,926 g of IVIg therapy. Six IVIg products were available, with domestically manufactured Intragam® P accounting for 89.7% of supply. The average age for first dose was 74 years. Males received 60.6% of the total treatment episodes representing 20% more than females. The average pre-treatment IgG level was 4.03 ± 2.03 g/L (range 0.30-10.50 g/L). A sustained average annual increased IVIg utilisation of 5.5% was observed. There was significant regional variation consistent with differences in prescriber preferences across states and territories. CONCLUSION This study provides a globally unique insight into IgRT supply and demand in CLL patients by analysis of total national use in Australia over a 6-year period.
Collapse
Affiliation(s)
- Anastazia Keegan
- Australian Red Cross Lifeblood, Perth, Western Australia, Australia
| | - Peta M Dennington
- Australian Red Cross Lifeblood, Alexandria, Sydney, New South Wales, Australia
| | - Nina Dhondy
- Australian Red Cross Lifeblood, Alexandria, Sydney, New South Wales, Australia.,Department of Haematology, Laverty Pathology, Sydney, New South Wales, Australia
| | - Stephen P Mulligan
- Department of Haematology, Laverty Pathology, Sydney, New South Wales, Australia.,Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
9
|
Prediction of clinical outcome in CLL based on recurrent gene mutations, CLL-IPI variables, and (para)clinical data. Blood Adv 2022; 6:3716-3728. [PMID: 35468622 PMCID: PMC9631547 DOI: 10.1182/bloodadvances.2021006351] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/06/2022] [Indexed: 12/03/2022] Open
Abstract
Baseline data (but not genetics) added to CLL-IPI variables improve predictive performance of ML models in CLL. Risk factors predictive of death within a 5-year outlook are mostly similar to risk factors predictive of infection within a 2-year outlook.
A highly variable clinical course, immune dysfunction, and a complex genetic blueprint pose challenges for treatment decisions and the management of risk of infection in patients with chronic lymphocytic leukemia (CLL). In recent years, the use of machine learning (ML) technologies has made it possible to attempt to untangle such heterogeneous disease entities. In this study, using 3 classes of variables (international prognostic index for CLL [CLL-IPI] variables, baseline [para]clinical data, and data on recurrent gene mutations), we built ML predictive models to identify the individual risk of 4 clinical outcomes: death, treatment, infection, and the combined outcome of treatment or infection. Using the predictive models, we assessed to what extent the different classes of variables are predictive of the 4 different outcomes, within both a short-term 2-year outlook and a long-term 5-year outlook after CLL diagnosis. By adding the baseline (para)clinical data to CLL-IPI variables, predictive performance was improved, whereas no further improvement was observed when including the data on recurrent genetic mutations. We discovered 2 main clusters of variables predictive of treatment and infection. Further emphasizing the high mortality resulting from infection in CLL, we found a close similarity between variables predictive of infection in the short-term outlook and those predictive of death in the long-term outlook. We conclude that at the time of CLL diagnosis, routine (para)clinical data are more predictive of patient outcome than recurrent mutations. Future studies on modeling genetics and clinical outcome should always consider the inclusion of several (para)clinical data to improve performance.
Collapse
|
10
|
Effects of B-Cell Lymphoma on the Immune System and Immune Recovery after Treatment: The Paradigm of Targeted Therapy. Int J Mol Sci 2022; 23:ijms23063368. [PMID: 35328789 PMCID: PMC8952275 DOI: 10.3390/ijms23063368] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 12/10/2022] Open
Abstract
B-cell lymphoma and lymphoproliferative diseases represent a heterogeneous and complex group of neoplasms that are accompanied by a broad range of immune regulatory disorder phenotypes. Clinical features of autoimmunity, hyperinflammation, immunodeficiency and infection can variously dominate, depending on the immune pathway most involved. Immunological imbalance can play a role in lymphomagenesis, also supporting the progression of the disease, while on the other hand, lymphoma acts on the immune system to weaken immunosurveillance and facilitate immunoevasion. Therefore, the modulation of immunity can have a profound effect on disease progression or resolution, which makes the immune system a critical target for new therapies. In the current therapeutic scenario enriched by chemo-free regimens, it is important to establish the effect of various drugs on the disease, as well as on the restoration of immune functions. In fact, treatment of B-cell lymphoma with passive immunotherapy that targets tumor cells or targets the tumor microenvironment, together with adoptive immunotherapy, is becoming more frequent. The aim of this review is to report relevant data on the evolution of the immune system during and after treatment with targeted therapy of B-cell lymphomas.
Collapse
|
11
|
Shen Y, Coyle L, Kerridge I, Stevenson W, Arthur C, McKinlay N, Fay K, Ward C, Greenwood M, Best OG, Solterbeck A, Guminski A, Shumack S, Mulligan SP. Second primary malignancies in chronic lymphocytic leukaemia: Skin, solid organ, haematological and Richter's syndrome. EJHAEM 2022; 3:129-138. [PMID: 35846218 PMCID: PMC9175984 DOI: 10.1002/jha2.366] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 11/20/2021] [Accepted: 11/24/2021] [Indexed: 05/12/2023]
Abstract
Chronic lymphocytic leukaemia (CLL) is invariably accompanied by some degree of immune failure, and CLL patients have a high rate of second primary malignancy (SPM) compared to the general population. We comprehensively documented the incidence of all forms of SPM including skin cancer (SC), solid organ malignancy (SOM), second haematological malignancy (SHM) and separately Richter's syndrome (RS) across all therapy eras. Among the 517 CLL/small lymphocytic lymphoma (SLL) patients, the overall incidence of SPMs with competing risks was SC 31.07%, SOM 25.99%, SHM 5.19% and RS 7.55%. Of the 216 treated patients, 106 (49.1%) had at least one form of SPM, and 63 of 106 (29.2% of treated patients) developed an SPM 1.5 years (median) after treatment for their CLL. Melanoma accounted for 30.3% of SC. Squamous cell carcinoma (SCC), including eight metastatic SCCs, was 1.8 times more than basal cell carcinoma (BCC), a reversal of the typical BCC:SCC ratio. The most common SOMs were prostate (6.4%) and breast (4.5%). SHM included seven acute myeloid leukaemia (AML) and five myelodysplasia (MDS) of which eight (four AML, four MDS) were therapy-related. Any SPM occurred in 32.1% of 53 Monoclonal B-lymphocytosis (MBL) patients. Age-adjusted standardised rates of SPM (per 100,000) for CLL, MBL and the general Australian population were 2648, 1855 and 486.9, respectively. SPMs are a major health burden with 44.9% of CLL patients with having at least one SPM, and apart from SC, associated with significantly reduced overall survival. Dramatic improvements in CLL treatment and survival have occurred with immunochemotherapy and targeted therapies, but mitigating SPM burden will be important to sustain further progress.
Collapse
Affiliation(s)
- Yandong Shen
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
- Kolling Institute of Medical ResearchRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Luke Coyle
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Ian Kerridge
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - William Stevenson
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Christopher Arthur
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Naomi McKinlay
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Keith Fay
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Christopher Ward
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Matthew Greenwood
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Oliver Giles Best
- College of Medicine and Public HealthFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Ann Solterbeck
- Statistical Revelations Pty LtdOcean GroveVictoriaAustralia
| | - Alexander Guminski
- Department of Medical OncologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Stephen Shumack
- Department of DermatologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| | - Stephen P. Mulligan
- Department of HaematologyRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
- Kolling Institute of Medical ResearchRoyal North Shore HospitalSt LeonardsNew South WalesAustralia
| |
Collapse
|
12
|
Shen Y, Freeman JA, Holland J, Solterbeck A, Naidu K, Soosapilla A, Downe P, Tang C, Kerridge I, Wallman L, Van Bilsen N, Milogiannakis V, Akerman A, Martins Costa Gomes G, Sandgren K, Cunningham AL, Turville S, Mulligan SP. COVID‐19 Vaccine Failure in Chronic Lymphocytic Leukaemia and Monoclonal B‐Lymphocytosis; Humoral and Cellular Immunity. Br J Haematol 2021; 197:41-51. [DOI: 10.1111/bjh.18014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/08/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Yandong Shen
- Department of Haematology Royal North Shore Hospital St Leonards NSW Australia
- Kolling Institute Royal North Shore Hospital St Leonards NSW Australia
| | - Jane A. Freeman
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
- Northern Haematology and Oncology Group Sydney Adventist Hospital Wahroonga NSW Australia
| | - Juliette Holland
- Department of Microbiology Laverty Pathology, Macquarie Park NSW Australia
| | - Ann Solterbeck
- Statistical Revelations Pty Ltd 41 The Parade, Ocean Grove VIC Australia
| | - Kartik Naidu
- Department of Microbiology Laverty Pathology, Macquarie Park NSW Australia
| | - Asha Soosapilla
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| | - Paul Downe
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| | - Catherine Tang
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| | - Ian Kerridge
- Department of Haematology Royal North Shore Hospital St Leonards NSW Australia
| | - Lucinda Wallman
- Department of Immunology Laverty Pathology, Macquarie Park NSW Australia
| | - Nenna Van Bilsen
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| | | | - Anouschka Akerman
- Kirby Institute University of New South Wales Kensington NSW Australia
| | | | - Kerrie Sandgren
- Centre for Virology Research Westmead Institute Sydney Infectious Diseases University of Sydney NSW Australia
| | - Anthony L Cunningham
- Centre for Virology Research Westmead Institute Sydney Infectious Diseases University of Sydney NSW Australia
| | - Stuart Turville
- Kirby Institute University of New South Wales Kensington NSW Australia
| | - Stephen P. Mulligan
- Department of Haematology Royal North Shore Hospital St Leonards NSW Australia
- Kolling Institute Royal North Shore Hospital St Leonards NSW Australia
- Department of Haematology and Flow Cytometry Laverty Pathology Macquarie Park NSW Australia
| |
Collapse
|
13
|
Agius R, Parviz M, Niemann CU. Artificial intelligence models in chronic lymphocytic leukemia - recommendations toward state-of-the-art. Leuk Lymphoma 2021; 63:265-278. [PMID: 34612160 DOI: 10.1080/10428194.2021.1973672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Artificial intelligence (AI), machine learning and predictive modeling are becoming enabling technologies in many day-to-day applications. Translation of these advances to the patient's bedside for AI assisted interventions is not yet the norm. With specific emphasis on CLL, here, we review the progress of prognostic models in hematology and highlight sources of stagnation that may be limiting significant improvements in prognostication in the near future. We discuss issues related to performance, trust, modeling simplicity, and prognostic marker robustness and find that the major limiting factor in progressing toward state-of-the-art prognostication within the hematological community, is not the lack of able AI algorithms but rather, the lack of their adoption. Current models in CLL still deal with the 'average' patient while the use of patient-centric approaches remains absent. Using lessons from research areas where machine learning has become an enabling technology, we derive recommendations and propose methods for achieving state-of-the-art predictions in modeling health data, that can be readily adopted by the CLL modeling community.
Collapse
Affiliation(s)
- Rudi Agius
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mehdi Parviz
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Carsten Utoft Niemann
- Department of Hematology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
14
|
Impact of Immune Parameters and Immune Dysfunctions on the Prognosis of Patients with Chronic Lymphocytic Leukemia. Cancers (Basel) 2021; 13:cancers13153856. [PMID: 34359757 PMCID: PMC8345723 DOI: 10.3390/cancers13153856] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary In chronic lymphocytic leukemia (CLL), immune alterations—affecting both the innate and adaptive immunity—are very common. As a clinical consequence, patients with CLL frequently present with autoimmune phenomena, increased risk of infections and second malignancies. The aim of this review article is to present available data on CLL-associated alterations of immune parameters that correlate with known prognostic markers and with clinical outcome. Also, data on the impact of immune-related clinical manifestations on the prognosis of patients with CLL will be discussed. Abstract Chronic lymphocytic leukemia (CLL) is characterized by a wide spectrum of immune alterations, affecting both the innate and adaptive immunity. These immune dysfunctions strongly impact the immune surveillance, facilitate tumor progression and eventually affect the disease course. Quantitative and functional alterations involving conventional T cells, γδ T cells, regulatory T cells, NK and NKT cells, and myeloid cells, together with hypogammaglobulinemia, aberrations in the complement pathways and altered cytokine signature have been reported in patients with CLL. Some of these immune parameters have been shown to associate with other CLL-related characteristics with a known prognostic relevance or to correlate with disease prognosis. Also, in CLL, the complex immune response dysfunctions eventually translate in clinical manifestations, including autoimmune phenomena, increased risk of infections and second malignancies. These clinical issues are overall the most common complications that affect the course and management of CLL, and they also may impact overall disease prognosis.
Collapse
|
15
|
Steingrímsson V, Gíslason GK, Þorsteinsdóttir S, Rögnvaldsson S, Gottfreðsson M, Aspelund T, Turesson I, Björkholm M, Landgren O, Kristinsson SY. A nationwide study on inpatient opportunistic infections in patients with chronic lymphocytic leukemia in the pre-ibrutinib era. Eur J Haematol 2020; 106:346-353. [PMID: 33211356 DOI: 10.1111/ejh.13553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Opportunistic infections in chronic lymphocytic leukemia (CLL) have been described in clinical trials, single-center studies, and case reports. We performed a nationwide study to estimate the incidence and impact of inpatient opportunistic infections. METHODS The incidence rate (IR) and incidence rate ratio (IRR) for Swedish CLL patients diagnosed 1994-2013, and matched controls were calculated, as well as the case-fatality ratio (CFR). RESULTS Among 8989 CLL patients, a total of 829 opportunistic infections were registered (IR 16.6 per 1000 person-years) compared with 252 opportunistic infections in 34 283 matched controls (IR 0.99). The highest incidence in the CLL cohort was for Pneumocystis pneumonia (200 infections, IR 4.03); Herpes zoster (146 infections, IR 2.94), and Pseudomonas (83 infections, IR 1.66) infections. The highest risk relative to matched controls was observed for Pneumocystis pneumonia (IRR 114, 95% confidence interval 58.7-252). The 60-day CFR for CLL patients with opportunistic infections was 23% (188/821), highest for progressive multifocal encephalopathy (5/7, 71%) and aspergillosis (25/60, 42%). CONCLUSION We have uniquely depicted the incidence of rare and serious infections in CLL patients and found a relatively high incidence of Pneumocystis pneumonia. Of the most common opportunistic infections, CLL patients with aspergillosis had the poorest prognosis.
Collapse
Affiliation(s)
| | | | | | | | - Magnús Gottfreðsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland
| | - Thor Aspelund
- Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Ingemar Turesson
- Department of Hematology and Coagulation Disorders, Skane University Hospital, Malmö, Sweden
| | - Magnus Björkholm
- Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Ola Landgren
- Myeloma Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Sigurdur Y Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
16
|
IgA levels at diagnosis predict for infections, time to treatment, and survival in chronic lymphocytic leukemia. Blood Adv 2020; 3:2188-2198. [PMID: 31324639 DOI: 10.1182/bloodadvances.2018026591] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 06/01/2019] [Indexed: 01/29/2023] Open
Abstract
To better understand the relationship between baseline immunoglobulin measurements and subsequent clinical outcomes in chronic lymphocytic leukemia (CLL), we performed a retrospective analysis on 660 patients with CLL (72%), monoclonal B-cell lymphocytosis (MBL) (13%), and small lymphocytic lymphoma (SLL) (14%), diagnosed between 2005 and 2014 at CancerCare Manitoba. Of 511 patients who had their first immunoglobulin level determined within 3 months of diagnosis, abnormal (either increased or decreased) immunoglobulin M (IgM), IgG, and IgA values were observed in 58% of patients with CLL, 27% of patients with MBL, and 20% of patients with SLL. Immunoglobulin deviances were similar for MBL and CLL Rai stage 0 and for SLL and Rai stages I and II; for CLL, IgG and IgA abnormalities occurred with increasing frequency with advancing Rai stage. In contrast, the frequency of IgM abnormalities was similar in all patient groups. IgA abnormalities significantly correlated with high β2-microglobulin (B2M) expression, whereas abnormal IgG and IgA levels were associated with the use of IGHV1-69, 3-21, and 3-49 subtypes. Increases in IgG or IgM were commonly associated with the presence of a CLL-type M-band, whereas oligoclonal bands were frequently observed with increased IgA levels. Although abnormal levels of IgG and IgA at diagnosis were independent predictors for future immunoglobulin replacement, only abnormal IgA levels were associated with shorter time to first treatment and overall survival. These findings indicate that both reduced and elevated levels of IgG and IgA at diagnosis are important and independent prognostic markers for infection in CLL, with IgA being more relevant as a marker of disease progression and survival.
Collapse
|
17
|
Machine learning can identify newly diagnosed patients with CLL at high risk of infection. Nat Commun 2020; 11:363. [PMID: 31953409 PMCID: PMC6969150 DOI: 10.1038/s41467-019-14225-8] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/11/2019] [Indexed: 12/14/2022] Open
Abstract
Infections have become the major cause of morbidity and mortality among patients with chronic lymphocytic leukemia (CLL) due to immune dysfunction and cytotoxic CLL treatment. Yet, predictive models for infection are missing. In this work, we develop the CLL Treatment-Infection Model (CLL-TIM) that identifies patients at risk of infection or CLL treatment within 2 years of diagnosis as validated on both internal and external cohorts. CLL-TIM is an ensemble algorithm composed of 28 machine learning algorithms based on data from 4,149 patients with CLL. The model is capable of dealing with heterogeneous data, including the high rates of missing data to be expected in the real-world setting, with a precision of 72% and a recall of 75%. To address concerns regarding the use of complex machine learning algorithms in the clinic, for each patient with CLL, CLL-TIM provides explainable predictions through uncertainty estimates and personalized risk factors. Chronic lymphocytic leukemia is an indolent disease, and many patients succumb to infection rather than the direct effects of the disease. Here, the authors use medical records and machine learning to predict the patients that may be at risk of infection, which may enable a change in the course of their treatment.
Collapse
|
18
|
Mulligan SP, Shumack S, Guminski A. Chronic lymphocytic leukemia, skin and other second cancers. Leuk Lymphoma 2019; 60:3104-3106. [DOI: 10.1080/10428194.2019.1665669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Stephen P. Mulligan
- Department of Haematology, Royal North Shore Hospital, St Leonards, Sydney, Australia
- Royal North Shore Hospital, Joint CLL Dermatology and Oncology Clinic, St Leonards, Sydney, Australia
| | - Stephen Shumack
- Royal North Shore Hospital, Joint CLL Dermatology and Oncology Clinic, St Leonards, Sydney, Australia
- Department of Dermatology, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Alexander Guminski
- Royal North Shore Hospital, Joint CLL Dermatology and Oncology Clinic, St Leonards, Sydney, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, Sydney, Australia
| |
Collapse
|