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Blood, 1 February 2008, Vol. 111, No. 3, pp. 1110-1116.
Prepublished online as a Blood First Edition Paper on November 6, 2007; DOI 10.1182/blood-2007-09-111492.
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Submitted September 19, 2007
Accepted October 30, 2007
Impact of immune thrombocytopenia on the clinical course of chronic lymphocytic leukemia
Carlo Visco, Marco Ruggeri, Maria Laura Evangelista, Roberto Stasi, Roberta Zanotti, Ilaria Giaretta, Achille Ambrosetti, Domenico Madeo, Giovanni Pizzolo, and Francesco Rodeghiero*
Department of Hematology, Ospedale S. Bortolo, Vicenza, Italy
Department of Medical Sciences, Ospedale "Regina Apostolorum", Albano Laziale, Italy
Department of Clinical and Experimental Medicine, Section of Hematology, University of Verona, Verona, Italy
* Corresponding author; email: rodeghiero{at}hemato.ven.it.
The prevalence, clinical characteristics, and prognostic significance of immune thrombocytopenia (IT) in patients with chronic lymphocytic leukemia (CLL) have not been clearly determined. To clarify this, we retrospectively analyzed 1278 consecutive newly diagnosed patients with CLL. Criteria for IT diagnosis included: rapid (<2 weeks) and severe fall (half of the initial level and below 100x109/L) of platelet count; normal or augmented megakariocytes in bone marrow; no or limited (not palpable) splenomegaly; no cytotoxic treatment in the preceeding month. Sixty-four patients (5%) were diagnosed with IT. The median time to IT from CLL diagnosis was 13 months (range 0-81), and median platelet count at IT diagnosis was 14 x 109/L (range, 1-71). Fifty-six of the 64 patients (87%) received treatment for IT. The probability of responding to treatment for IT was significantly higher for patients receiving chemotherapy +/- steroids than for patients treated with intravenous immunoglobulins +/- steroids (p=0.01). The development of IT was significantly associated with un-mutated IgVh, a positive direct antiglobulin test, and the occurrence of autoimmune hemolytic anemia. Patients with CLL and IT had poorer survival than other patients with CLL (5-year OS 64% vs 82%, p=0.0005), and this effect was independent from common clinical prognostic variables.
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