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A Concise Review of Autoimmune Cytopenias in Chronic Lymphocytic Leukemia.
- Source :
-
Current hematologic malignancy reports [Curr Hematol Malig Rep] 2017 Feb; Vol. 12 (1), pp. 29-38. - Publication Year :
- 2017
-
Abstract
- Chronic lymphocytic leukemia (CLL) is frequently associated with autoimmune complications such as autoimmune hemolytic anemia, immune thrombocytopenia, pure red cell aplasia, and autoimmune granulocytopenia. It is critical to diagnose cytopenias from these secondary complications of CLL accurately, since prognosis and therapy are substantially different from patients who have cytopenias due to extensive bone marrow infiltration by CLL. The pathogenesis of autoimmune cytopenias in CLL is complex; and it involves antigen presentation by CLL cells to polyclonal B cells resulting in production of autoantibody, and alteration of the T cell milieu tilting the balance in favor of an autoimmune response. Traditional therapy of autoimmune complications in CLL consists of immunosuppression with corticosteroids and/or anti-CD20 monoclonal antibodies. In patients who have a suboptimal response, treating the underlying CLL is generally effective in ameliorating secondary cytopenias. Although novel oral therapies such as ibrutinib, idelalisib, and venetoclax have been shown to be extremely effective in the management of CLL, prospective data from larger numbers of patients with longer follow-up are needed prior to recommending their routine use in the management of autoimmune cytopenias in CLL.
- Subjects :
- Agranulocytosis complications
Agranulocytosis drug therapy
Agranulocytosis epidemiology
Anemia, Hemolytic, Autoimmune complications
Anemia, Hemolytic, Autoimmune diagnosis
Anemia, Hemolytic, Autoimmune drug therapy
Anemia, Hemolytic, Autoimmune epidemiology
Humans
Immunosuppressive Agents therapeutic use
Leukemia, Lymphocytic, Chronic, B-Cell complications
Leukemia, Lymphocytic, Chronic, B-Cell drug therapy
Protein Kinase Inhibitors therapeutic use
Red-Cell Aplasia, Pure complications
Red-Cell Aplasia, Pure drug therapy
Red-Cell Aplasia, Pure epidemiology
Rituximab administration & dosage
Thrombocytopenia complications
Thrombocytopenia drug therapy
Thrombocytopenia epidemiology
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Leukemia, Lymphocytic, Chronic, B-Cell pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1558-822X
- Volume :
- 12
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Current hematologic malignancy reports
- Publication Type :
- Academic Journal
- Accession number :
- 28197963
- Full Text :
- https://doi.org/10.1007/s11899-017-0366-1