Basis for infections in a patient with CLL:
(1) hypogammaglobulinemia
(2) T cell dysfunction
(3) immunosuppressive therapy, including stem cell transplantation
(4) comorbid conditions
(5) neutropenia or neutrophil dysfunction
Major infection: one that requires hospital admission and intravenous antibiotics
Major infections may include: sepsis, pneumonia, CNS infection, urinary tract infection, gastrointestinal infection
Risk factors for a serious infection occurring early from multivariate analysis:
(1) Binet stage B or C
(2) absence of IgVH gene mutation (unmutated)
Additional risk factors for an early serious infection:
(1) age > 70 years
(2) CD38 positive
(3) genetic abnormalities (p53, ataxia-telangiectasis mutation or ATM, trisomy 12)
(4) hypo-IgM (< 50 mg/dL)
(5) first chemotherapy regimen not including chlorambucil
Risk factors for infection-related mortality from multivariate analysis:
(1) age > 70 years
(2) Binet stage B or C
Additional risk factors for infection-related mortality:
(1) absence of IgVH gene mutation (unmutated)
(2) genetic abnormalities (p53, ataxia-telangiectasis mutation or ATM, trisomy 12)
IgVH mutation status was constant and reproducible. Other molecular factors (CD38, genetic abnormalities) were found to vary over the course of the illness and did not have established cutoff values.
