SECONDARY CANCERS, MAJOR INFECTIONS AND AUTOIMMUNE DISEASES OCCUR IN DIFFERENT SUBSETS OF PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA
(Abstract release date: 05/19/16)
EHA Library. Visentin A. 06/09/16; 132613; E1064
Disclosure(s): All the authors have nothing to disclose.
Dr. Andrea Visentin
Contributions
Contributions
Abstract
Abstract: E1064
Type: Eposter Presentation
Background
Chronic lymphocytic leukemia (CLL), the most common leukemia in western country, is still an incurable disease and the most relevant complications are major infections (MI), second cancers (SC) and autoimmune diseases (AD).
Aims
The aim of this study was to define the prevalence, risk factors and the evaluation of the impact of MI, SC and AD on the survival of CLL patients
Methods
We retrospectively analyzed clinical and biological data from 795 patients referred to Hematology and Clinical Immunology Unit of Padua University hospital. MI, were defined as those infective events that required in patients management or the use of intravenous antibiotics. SC comprised all other malignancies; while low and high-grade dysplasia were excluded. AD included all autoimmune and immune-mediate diseases.FISH analysis (n=598), CD38 expression (n=656), IGHV mutations (n=507) and TP53 abnormalities (n=527, account for TP53 deletion and mutation) were evaluated according to international guidelines. Statistical analyses were performed with Fisher exact test, Chi-square test, Log-rank test, Kaplan-Meier method and Cox model. Overall survival was calculated from the date of diagnosis to death (event) or last available follow-up (censored).
Results
With a median follow-up of almost 100 months, thirty-four percent of patients developed at least one complication among MI, SC and AD with 95% of them being occurred after CLL diagnosis (Figure 1A).Ninety-eight patients experienced 138 MI, among which pneumonia (65%), septic shock (13%) and deep tissue abscess (10%) were the most common. 120 patients reported 187 SC; skin cancer (32%), colon cancer (16%) and other-hematological malignancies (14%) resulted to be the most common SC. Eighty patients were diagnosed with 103 AD, the most common of which resulted to be hematological (41%), rheumatologic (17%) and thyroid-related diseases (16%).We observed that only 0.9% of the cohort developed all the complications and that 1.4% experienced both SC and AD, 1.8% both MI and AD, and 3.9% both MI and SC during the follow-up period (Figure 1B). These data suggest a low probability to develop two or three complications and, as shown in Figure 1C, they seem to occur in a mutually exclusively manner.MI were found with a higher prevalence in males, in previously treated patients and in those with high-risk cytogenetic by FISH and TP53 abnormalities. SC resulted to be more common in male, in advance Rai and Binet stages at diagnosis, in previously treated patients, in high-risk FISH and TP53 abnormalities. AD were more common in female, in advance stage disease and in patients with 11q. No associations were found between specific treatments.The estimated median time to SC and MI development were 20 and 21 years, respectively; while it was not reached for AD. After 20 years from the diagnosis SC, MI and AD occurred in 48%, 42% and 29% of patients, respectively. Kaplan-Meyer analysis showed that patients who developed a MI had the worst prognosis whereas those with AD had the best; in fact medians overall survival were 14.14 and 17.16 years form MI and SC groups, while it was not reached for AD and all others patients not included in the three groups.These data were confirmed in multivariate analyses; MI and SC have a negative impact on the overall survival among with TP53 abnormalities and IGHV mutations (HR 2.04, 1.50, 2.25 and 3.70, respectively).
Conclusion
We herein provide evidence for the existence of clinical subsets with different predispositions to develop major infections or secondary cancers or autoimmune diseases, with significant impact of the survival of CLL patients.
Session topic: E-poster
Keyword(s): Autoimmune disease, Infection, Second malignancy
Type: Eposter Presentation
Background
Chronic lymphocytic leukemia (CLL), the most common leukemia in western country, is still an incurable disease and the most relevant complications are major infections (MI), second cancers (SC) and autoimmune diseases (AD).
Aims
The aim of this study was to define the prevalence, risk factors and the evaluation of the impact of MI, SC and AD on the survival of CLL patients
Methods
We retrospectively analyzed clinical and biological data from 795 patients referred to Hematology and Clinical Immunology Unit of Padua University hospital. MI, were defined as those infective events that required in patients management or the use of intravenous antibiotics. SC comprised all other malignancies; while low and high-grade dysplasia were excluded. AD included all autoimmune and immune-mediate diseases.FISH analysis (n=598), CD38 expression (n=656), IGHV mutations (n=507) and TP53 abnormalities (n=527, account for TP53 deletion and mutation) were evaluated according to international guidelines. Statistical analyses were performed with Fisher exact test, Chi-square test, Log-rank test, Kaplan-Meier method and Cox model. Overall survival was calculated from the date of diagnosis to death (event) or last available follow-up (censored).
Results
With a median follow-up of almost 100 months, thirty-four percent of patients developed at least one complication among MI, SC and AD with 95% of them being occurred after CLL diagnosis (Figure 1A).Ninety-eight patients experienced 138 MI, among which pneumonia (65%), septic shock (13%) and deep tissue abscess (10%) were the most common. 120 patients reported 187 SC; skin cancer (32%), colon cancer (16%) and other-hematological malignancies (14%) resulted to be the most common SC. Eighty patients were diagnosed with 103 AD, the most common of which resulted to be hematological (41%), rheumatologic (17%) and thyroid-related diseases (16%).We observed that only 0.9% of the cohort developed all the complications and that 1.4% experienced both SC and AD, 1.8% both MI and AD, and 3.9% both MI and SC during the follow-up period (Figure 1B). These data suggest a low probability to develop two or three complications and, as shown in Figure 1C, they seem to occur in a mutually exclusively manner.MI were found with a higher prevalence in males, in previously treated patients and in those with high-risk cytogenetic by FISH and TP53 abnormalities. SC resulted to be more common in male, in advance Rai and Binet stages at diagnosis, in previously treated patients, in high-risk FISH and TP53 abnormalities. AD were more common in female, in advance stage disease and in patients with 11q. No associations were found between specific treatments.The estimated median time to SC and MI development were 20 and 21 years, respectively; while it was not reached for AD. After 20 years from the diagnosis SC, MI and AD occurred in 48%, 42% and 29% of patients, respectively. Kaplan-Meyer analysis showed that patients who developed a MI had the worst prognosis whereas those with AD had the best; in fact medians overall survival were 14.14 and 17.16 years form MI and SC groups, while it was not reached for AD and all others patients not included in the three groups.These data were confirmed in multivariate analyses; MI and SC have a negative impact on the overall survival among with TP53 abnormalities and IGHV mutations (HR 2.04, 1.50, 2.25 and 3.70, respectively).
Conclusion
We herein provide evidence for the existence of clinical subsets with different predispositions to develop major infections or secondary cancers or autoimmune diseases, with significant impact of the survival of CLL patients.
Session topic: E-poster
Keyword(s): Autoimmune disease, Infection, Second malignancy
Abstract: E1064
Type: Eposter Presentation
Background
Chronic lymphocytic leukemia (CLL), the most common leukemia in western country, is still an incurable disease and the most relevant complications are major infections (MI), second cancers (SC) and autoimmune diseases (AD).
Aims
The aim of this study was to define the prevalence, risk factors and the evaluation of the impact of MI, SC and AD on the survival of CLL patients
Methods
We retrospectively analyzed clinical and biological data from 795 patients referred to Hematology and Clinical Immunology Unit of Padua University hospital. MI, were defined as those infective events that required in patients management or the use of intravenous antibiotics. SC comprised all other malignancies; while low and high-grade dysplasia were excluded. AD included all autoimmune and immune-mediate diseases.FISH analysis (n=598), CD38 expression (n=656), IGHV mutations (n=507) and TP53 abnormalities (n=527, account for TP53 deletion and mutation) were evaluated according to international guidelines. Statistical analyses were performed with Fisher exact test, Chi-square test, Log-rank test, Kaplan-Meier method and Cox model. Overall survival was calculated from the date of diagnosis to death (event) or last available follow-up (censored).
Results
With a median follow-up of almost 100 months, thirty-four percent of patients developed at least one complication among MI, SC and AD with 95% of them being occurred after CLL diagnosis (Figure 1A).Ninety-eight patients experienced 138 MI, among which pneumonia (65%), septic shock (13%) and deep tissue abscess (10%) were the most common. 120 patients reported 187 SC; skin cancer (32%), colon cancer (16%) and other-hematological malignancies (14%) resulted to be the most common SC. Eighty patients were diagnosed with 103 AD, the most common of which resulted to be hematological (41%), rheumatologic (17%) and thyroid-related diseases (16%).We observed that only 0.9% of the cohort developed all the complications and that 1.4% experienced both SC and AD, 1.8% both MI and AD, and 3.9% both MI and SC during the follow-up period (Figure 1B). These data suggest a low probability to develop two or three complications and, as shown in Figure 1C, they seem to occur in a mutually exclusively manner.MI were found with a higher prevalence in males, in previously treated patients and in those with high-risk cytogenetic by FISH and TP53 abnormalities. SC resulted to be more common in male, in advance Rai and Binet stages at diagnosis, in previously treated patients, in high-risk FISH and TP53 abnormalities. AD were more common in female, in advance stage disease and in patients with 11q. No associations were found between specific treatments.The estimated median time to SC and MI development were 20 and 21 years, respectively; while it was not reached for AD. After 20 years from the diagnosis SC, MI and AD occurred in 48%, 42% and 29% of patients, respectively. Kaplan-Meyer analysis showed that patients who developed a MI had the worst prognosis whereas those with AD had the best; in fact medians overall survival were 14.14 and 17.16 years form MI and SC groups, while it was not reached for AD and all others patients not included in the three groups.These data were confirmed in multivariate analyses; MI and SC have a negative impact on the overall survival among with TP53 abnormalities and IGHV mutations (HR 2.04, 1.50, 2.25 and 3.70, respectively).
Conclusion
We herein provide evidence for the existence of clinical subsets with different predispositions to develop major infections or secondary cancers or autoimmune diseases, with significant impact of the survival of CLL patients.
Session topic: E-poster
Keyword(s): Autoimmune disease, Infection, Second malignancy
Type: Eposter Presentation
Background
Chronic lymphocytic leukemia (CLL), the most common leukemia in western country, is still an incurable disease and the most relevant complications are major infections (MI), second cancers (SC) and autoimmune diseases (AD).
Aims
The aim of this study was to define the prevalence, risk factors and the evaluation of the impact of MI, SC and AD on the survival of CLL patients
Methods
We retrospectively analyzed clinical and biological data from 795 patients referred to Hematology and Clinical Immunology Unit of Padua University hospital. MI, were defined as those infective events that required in patients management or the use of intravenous antibiotics. SC comprised all other malignancies; while low and high-grade dysplasia were excluded. AD included all autoimmune and immune-mediate diseases.FISH analysis (n=598), CD38 expression (n=656), IGHV mutations (n=507) and TP53 abnormalities (n=527, account for TP53 deletion and mutation) were evaluated according to international guidelines. Statistical analyses were performed with Fisher exact test, Chi-square test, Log-rank test, Kaplan-Meier method and Cox model. Overall survival was calculated from the date of diagnosis to death (event) or last available follow-up (censored).
Results
With a median follow-up of almost 100 months, thirty-four percent of patients developed at least one complication among MI, SC and AD with 95% of them being occurred after CLL diagnosis (Figure 1A).Ninety-eight patients experienced 138 MI, among which pneumonia (65%), septic shock (13%) and deep tissue abscess (10%) were the most common. 120 patients reported 187 SC; skin cancer (32%), colon cancer (16%) and other-hematological malignancies (14%) resulted to be the most common SC. Eighty patients were diagnosed with 103 AD, the most common of which resulted to be hematological (41%), rheumatologic (17%) and thyroid-related diseases (16%).We observed that only 0.9% of the cohort developed all the complications and that 1.4% experienced both SC and AD, 1.8% both MI and AD, and 3.9% both MI and SC during the follow-up period (Figure 1B). These data suggest a low probability to develop two or three complications and, as shown in Figure 1C, they seem to occur in a mutually exclusively manner.MI were found with a higher prevalence in males, in previously treated patients and in those with high-risk cytogenetic by FISH and TP53 abnormalities. SC resulted to be more common in male, in advance Rai and Binet stages at diagnosis, in previously treated patients, in high-risk FISH and TP53 abnormalities. AD were more common in female, in advance stage disease and in patients with 11q. No associations were found between specific treatments.The estimated median time to SC and MI development were 20 and 21 years, respectively; while it was not reached for AD. After 20 years from the diagnosis SC, MI and AD occurred in 48%, 42% and 29% of patients, respectively. Kaplan-Meyer analysis showed that patients who developed a MI had the worst prognosis whereas those with AD had the best; in fact medians overall survival were 14.14 and 17.16 years form MI and SC groups, while it was not reached for AD and all others patients not included in the three groups.These data were confirmed in multivariate analyses; MI and SC have a negative impact on the overall survival among with TP53 abnormalities and IGHV mutations (HR 2.04, 1.50, 2.25 and 3.70, respectively).
Conclusion
We herein provide evidence for the existence of clinical subsets with different predispositions to develop major infections or secondary cancers or autoimmune diseases, with significant impact of the survival of CLL patients.
Session topic: E-poster
Keyword(s): Autoimmune disease, Infection, Second malignancy
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