Francis et al identified risk factors associated with major infections in patients with chronic lymphocytic leukemia (CLL). A patient with risk factors may benefit from more aggressive and from prophylactic therapy. The authors are from Birmingham Heartlands Hospital, Wales School of Medicine in Cardiff, and Hospital de la Santa Creu I Sant Pau in Barcelona.


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.


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