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The effect of immunoglobulin VH gene mutation status and other prognostic factors on the incidence of major infections in patients with chronic lymphocytic leukemia
Article first published online: 21 JUL 2006
Copyright © 2006 American Cancer Society
Volume 107, Issue 5, pages 1023–1033, 1 September 2006
How to Cite
Francis, S., Karanth, M., Pratt, G., Starczynski, J., Hooper, L., Fegan, C., Pepper, C., Valcarcel, D., Milligan, D. W. and Delgado, J. (2006), The effect of immunoglobulin VH gene mutation status and other prognostic factors on the incidence of major infections in patients with chronic lymphocytic leukemia. Cancer, 107: 1023–1033. doi: 10.1002/cncr.22094
- Issue published online: 21 AUG 2006
- Article first published online: 21 JUL 2006
- Manuscript Accepted: 15 MAY 2006
- Manuscript Revised: 2 MAY 2006
- Manuscript Received: 17 MAR 2006
- chronic lymphocytic leukemia;
- immunoglobulin VH mutation status;
Infections are a major factor in the clinical course of chronic lymphocytic leukemia (CLL) and account for 30% to 50% of all deaths. The pathogenesis of infections in CLL is related to hypo-γ-globulinemia, T-cell immune dysfunction, and the immunosuppressive effect of treatment.
The authors retrospectively assessed the correlations between new prognostic markers and types of infections encountered, the time taken to develop these infections, and infection-related mortality in 280 unselected patients with CLL.
One hundred patients (36%) had at least 1 major infection (median, 2 major infections; range, 1–8 major infections) over a median follow-up of 67 months. Infections were the most common cause of death, accounting for 51% of all fatalities. Older age (P = .007), clinical Stage B or C disease (P < .001), unmutated immunoglobulin (Ig)VH gene status (P < .001), genetic abnormalities (P < .001), positive CD38 status (P < .001), and type of initial therapy were associated with a significantly shorter time to first infection. Equally, patient age (P < .001), disease stage (P < .001), CD38 expression (P < .001), IgVH mutation status (P < .001), and genetic abnormalities (P = .003) had a significant impact on infection-related mortality.
Clinical stage at diagnosis, IgVH mutation status, and initial therapy were possible predictors of severe infections in patients with CLL. The current results may help to identify which patients with CLL are at particularly high risk of developing serious infections and, thus, should be considered for Ig or antibiotic prophylaxis. Cancer 2006. © 2006 American Cancer Society.