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Chronic lymphocytic leukemia (CLL) is the most common leukemia in Western countries including Israel, and is less frequent in the Orient, Asia and Middle Eastern Arabic speaking countries. These trends persist in migrants to other countries, continuing into subsequent generations. Biological and genetic disparities have been reported for different ethnic groups. The absence of an association between place of birth and the occurrence of CLL is more in line with a genetic basis for the geographic variations in incidence. Genetic predisposition to CLL is supported by the documented familial aggregation of CLL, with an increased frequency of 8.5-fold among first-degree relatives of patients with CLL and the detection of CLL-like clones in 13.5% of first-degree relatives. It is likely that the development of CLL depends on the interplay of a genetic predisposition with exposure to environmental factors. To better understand the interplay of ethnicity and CLL we reviewed all the available literature on ethnic specific differences for this common form of leukemia. [ABSTRACT FROM AUTHOR]

An insect-bite-like reaction is known to occur in patients with chronic lymphocytic leukemia ( CLL). Most of the literature, however, consists of isolated case reports or small case series. The aim of this retrospective study was to review the national experience with insect-bite-like reaction in a large group of patients with CLL. The study cohort of patients with these skin reactions consisted of 48 patients (25 males, 23 females) of mean age 64.8 yr (range 33-89) at skin eruption. Data on clinical, histologic, immunophenotypic, and cytogenetic characteristics, treatment, and outcome were collected from the medical files. Mean time between diagnosis of CLL and appearance of the skin lesions was 3.1 yr (range −4 to 14 yr). The eruption was not related to disease activity or the course of the hematological disease. The eruption preceded the diagnosis of CLL in 10 patients (by 0-4 yr); and followed the diagnosis in 36; in 11 patients, it occurred during therapy for CLL and in nine after therapy. Mean duration of the skin findings was 21.5 months (range 0.3-132). The eruption usually presented in summer, although it occurred also at other times of the year, and predominantly affected the upper and lower limbs, although it also appeared on unexposed areas. Treatment included local ointments, antihistaminics, oral steroids, antibiotics, phototherapy, and dapsone with varying responses. Insect-bite-like reactions is a relatively common and disturbing skin reaction in CLL patients, it may be related to the immune dysregulation accompanying CLL and further exacerbated by external factors, including actual insect bites, chemoimmunotherapy, and pyogenic infection. [ABSTRACT FROM AUTHOR]

Using the database of the Israeli CLL Study Group, we investigated the incidence and prognostic significance of CD25 expression on the surface of lymphocytic leukemia cells. Strong CD25 expression was found in 46 (16.4 %) of 281 tested cases and was correlated with the presence of splenomegaly ( p = 0.04), expression of CD38 antigen ( p = 0.001), and FMC-7 ( p = 0.04). Age, gender, Binet stage, circulating lymphocyte count, presence of anemia or thrombocytopenia, atypical cell morphology, serum beta 2-microglobulin level, and ZAP-70 expression did not differ in patients with or without cell surface CD25. There was no correlation between CD25 expression and time to first treatment or overall survival. CD25 expression does not appear to be a prognostic factor in CLL. [ABSTRACT FROM AUTHOR]

Although the incidence of chronic lymphocytic leukemia (CLL) increases exponentially with age, data on patients 80 years or older at diagnosis are sparse. The records of patients diagnosed with CLL at age ≥80 years at seven medical centers in Israel during 1979-2009 were reviewed. Patients included 118 men and 96 women with a mean age of 84 years (range 80-94). Diagnosis was established in 56.5% due to routine blood count; 56% had Rai stage 0 disease and 25% of the patients received treatment. By June 2010, 72% had died. Mean survival was 67.7 months (median 56 ± 5.4 months) and 5-year survival rate 47.2 ± 3.6%. On univariate analysis, factors associated with better survival were age <84 years ( p = 0.002), early Rai and Binet stages ( p = 0.023, 0.003), low white blood cell count at time of diagnosis ( p = 0.015), low β2 microglobulin level ( p = 0.006), diagnosis by routine blood test ( p < 0.001), and low CD38 level ( p = 0.036). Multivariate analysis using Cox regression revealed that younger age, low white cell count, and diagnosis by routine blood test were independent predictors of good prognosis (hazards ratios 1.8, 1.6, and 1.9, respectively). Patients diagnosed with CLL at age ≥80 years may expect to live a long life. This study identifies several factors predicting good prognosis which are easy to obtain. [ABSTRACT FROM AUTHOR]