Overview of the complications of chronic lymphocytic leukemia
- Kanti R Rai, MD
Kanti R Rai, MD
- Professor of Medicine and Molecular Medicine
- Hofstra North Shore-LIJ School of Medicine at Hofstra University
- Stephan Stilgenbauer, MD
Stephan Stilgenbauer, MD
- Professor of Medicine
- Ulm University
Chronic lymphocytic leukemia (CLL) is characterized by the progressive accumulation of usually monoclonal, functionally incompetent lymphocytes. Patients with CLL commonly develop complications associated with the intrinsic immune dysfunction that results in immunodeficiency and the development of autoimmune disorders.
The major complications of CLL will be discussed here. The diagnosis of CLL and treatment of the underlying disorder are presented separately. The risk of infections and prevention of infections in patients with CLL are also discussed in detail separately. (See "Clinical presentation, pathologic features, diagnosis, and differential diagnosis of chronic lymphocytic leukemia" and "Overview of the treatment of chronic lymphocytic leukemia" and "Risk of infections in patients with chronic lymphocytic leukemia" and "Prevention of infections in patients with chronic lymphocytic leukemia".)
Immune defects — Patients with CLL have abnormal cellular and humoral-mediated immune responses due to quantitative and qualitative defects in immune effector cells. These defects can be due to the underlying disease process or to therapy used for treatment. This is described in more detail separately. (See "Risk of infections in patients with chronic lymphocytic leukemia", section on 'Immune defects'.)
Incidence and infectious agents — Infection is a major cause of death in patients with CLL [1-5]. The incidence of major infection increases with disease stage and active treatment [5,6]. Most infections occur late in the disease course, due to a combination of bone marrow infiltration and therapy-induced immune dysfunction [1,2,7].
The spectrum of infections in patients with CLL has changed over the past several decades with the introduction of CLL therapies that have specific effects on immune function, particularly on cell-mediated immunity. The infectious complications seen in these patients have evolved in relation to the specific agents used and is discussed separately in relation to the various classes of CLL therapy. (See "Risk of infections in patients with chronic lymphocytic leukemia", section on 'Spectrum of infections'.)
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- Immune defects
- Incidence and infectious agents
- - Vaccination
- - Antimicrobials
- - IVIG
- - Growth factors
- COLITIS AND HEPATOTOXICITY
- Autoimmune hemolytic anemia
- - Diagnosis
- - Management
- Red cell aplasia
- - Identification
- - Therapy
- Chemotherapy induced anemia
- Advanced disease
- Immune thrombocytopenia
- PSYCHOLOGICAL DISTRESS
- SECOND CANCERS
- TUMOR LYSIS SYNDROME
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS