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Alert Number 240
Date: July 5, 2024
Conventional wisdom just a few years ago said that if your red blood cell counts tanked and you were anemic, or your platelet counts fell through the floor, you were automatically consigned to advanced disease - high Rai stage.
That is no longer the guidance to patients and their healthcare providers. Anemia and low platelets are still important, but it is also important to know why this could be happening. If your bone marrow is so damaged that it can no longer make red blood cells or platelets, then you really do have a problem, you are correctly assigned to the late stage disease group. But if your anemia is caused by autoimmune destruction of red blood cells by your own body, or if your low platelet counts are similarly due to destruction of perfectly good platelets by an immune system gone nuts (AIHA and ITP respectively), the outlook is a little better. Autoimmune disease can be treated, there are a number of ways of controlling this out-of-control immune system problem. A bone marrow that has given up the ghost is a whole different kettle of fish, just about the only solution is a bone marrow (stem cell) transplant. CLL patients must learn to appreciate even the smallest silver lining to the very dark cloud we live under. Right?
AIHA and ITP are important complications, and they have an impact on your therapy decisions. You would be surprised how many local oncologists are not exactly sure about autoimmune disease, how to diagnose it, how to treat it, how to evaluate it. I know, because I hear from dozens of you out there each month, telling me the gory stories. (Ahem, that was an unintentional pun. “Gory” story, you get it?)
I am happy to bring to your attention the latest article out of Mayo Clinic. Clive Zent is one of my favorite CLL experts. He is a terrific diagnostician. I send him all the really tough cases that come to me for referral. He could play “House” on my favorite TV show, and he would not even have to sleep at the Holiday Express. This article describes the whys and wherefores of autoimmune disease, as well as rigorous listing of the diagnostic criteria before AIHA or ITP can be confirmed. I was also interested to see that Clive brings up the issue of Campath as a possible offender in causing autoimmune disease. Do you know the Campath black box label now carries a warning about risk of ITP? This came about when a significant number of MS patients developed ITP after getting Campath. We discussed this in greater detail in a recent article on our website, concerning regulatory T-cells or Tregs.
If you wish to get hold of a copy of the full text article, write and let us know. Here are a couple of links to prior articles, if you wish to read up on this subject.
Tregs revealed;
Rai and Binet staging need updating.
Be well,
Chaya
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Clin Adv Hematol Oncol. 2024 Apr;5(4):257-61.
Diagnosis and management of autoimmune complications of chronic lymphocytic leukemia/small lymphocytic lymphoma
Ding W, Zent CS.
Division of Hematology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905.
Autoimmmune cytopenia is an important but poorly understood clinical complication of chronic lymphocytic leukemia/ small lymphocytic lymphoma. We review the pathogenesis, clinical presentation, and management of autoimmune hemolytic anemia, immune thrombocytopenia, and pure red blood cell aplasia in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma.
PMID: 17607284
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