Autoimmune phenomena may complicate the clinical course of chronic lymphocytic leukemia (CLL). Autoimmune cytopenias (AC) are much more common than other non hematologic complications, sometimes representing the first appearance of the disease .
'The clinical course of chronic lymphocytic leukemia (CLL) may be complicated at any time by autoimmune phenomena.The most common ones are hematologic disorders, such as autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP). Pure red cell aplasia (PRCA) and autoimmune agranulocytosis (AG) are, indeed, more rarely seen. However, they are probably underestimated due to the possible misleading presence of cytopenias secondary to leukemic bone marrow involvement or to chemotherapy cytotoxicity. The source of autoantibodies is still uncertain, despite the most convincing data are in favor of the involvement of resting normal B-cells. In general, excluding the specific treatment of underlying CLL, the management of these complications is not different from that of idiopathic autoimmune cytopenias or of those associated to other causes. Among different therapeutic approaches, monoclonal antibody rituximab, given alone or in combination, has shown to be very effective.'
Reading this paper reinforces how much we don't know when it comes to what causes autoimmune phenomena in CLL. Still well worth reading if your particular flavour of SLL/CLL involves lowered platelets, red blood cells, neutrophils, etc.
Interesting to read Cyclophosphamide and Rituximab (the CR in FCR) can help and that splenectomies should be considered with more caution.
I got confirmation I have AIHA today: this is only months after CLL diagnosis! So I am not sure I like what I read on prognosis in this paper....still better prepared than not. However, I will have to get a friendly GP to translate into plain english before I get too carried away
Still, the AIHA explains my big spleen (see 'Big Spleen' blog of a few days ago) and I somehow mis-heard my consultant: steriods is first line of treatment.....splenectomy comes later if steriods don't work (1 out of 3 cases by the sounds of things)
The British Journal of Heamotology 'Guideline' paper that Hairbear put under that blog ('Big Spleen') is in line with this paper. All GPs should get this paper - the ones I know 'out of work hours' appear not to know of its existence.....
I do have great haematologist - she was one of the authors of the paper! I hope all haemotologists know this. However, I have shown paper to GP friends and they are greatly appreciative re helping their background knowledge - they are learning a lot from my incessent questions! YEs they won't provide the treatment, but they are on the fringes and more knowledge is not a bad thing.
At Consultation yesterday, I am about to start steroids to reduce spleen - hope this works. The good news is I queried the prognosis claims of these new US papers. She does not believe them, saying they confuse a lot of factors [eg (there was a trend (years ago) that some CLL treatments re-inforced autoimmune aspects, so patients were withheld some CLL treatment when they should have got it. So they died quicker than general CLLers of that era.....]
Also, as I suspected, the papers effectively look at treatments 15 to 20 years ago (because patiants lasted 10 years +, but are now dead)
My interpretation is that she thinks there is, if any, only a very weak link in autoimmune complications reducing prognosis times. So phew!
Saw your response to the poll but thought it better to respond to you here.
I was diagnosed at the same age as you - just before I turned 54. I thought it strange that my haematologist said after giving me my diagnosis, "You're young, we can help you", not feeling particularly young while approaching my mid 50's. With a bit more knowledge behind me now, I understand what she meant - us 'younger' patients can better withstand chemo that is more challenging later in life.
Wishing you success with the steroid treatment; I recommend you check with your GP friends and on line on how to best manage any side effects.
Here's to a long W&W; the poll responses should be reassuring!
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