Liver dysfunction in chronic lymphocytic leukemia: Prevalence, outcomes, and pathological findings

Paul J. Hampel, Kari G. Chaffee, Rebecca King, Douglas Simonetto, Melissa C. Larson, Sara Achenbach, Timothy G. Call, Wei D Ding, Saad Kenderian, Jose F. Leis, Asher A Chanan Khan, Deborah A. Bowen, Michael J. Conte, Susan M. Schwager, Curtis A. Hanson, Susan L Slager, Neil Elliot Kay, Tait D. Shanafelt, Sameer A Parikh

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Abstract

The prevalence of liver dysfunction and its association with outcomes in patients with previously untreated chronic lymphocytic leukemia (CLL) is unknown. Newly diagnosed (<12 months) previously untreated CLL patients seen at Mayo Clinic, Rochester, MN between 9/1993 and 4/2016 who had baseline assessment of at least one liver function test (LFT) were included in this analysis. The prevalence of liver dysfunction at baseline, proportion of patients who acquired LFT abnormalities, time to first therapy (TTFT) and overall survival (OS) were assessed. An abnormal LFT was present in 82/2336 (3.5%) patients at diagnosis and was associated with advanced Rai stage (Rai III–IV) (21% vs. 6%; P <.001), lower hemoglobin (13.1 g/dL vs. 13.9 g/dL; P <.001), and lower platelet count (187 × 109/L vs. 200 × 109/L; P =.03). Additionally, 236 patients with normal LFTs at diagnosis developed acquired liver dysfunction during follow-up. Patients with abnormal LFTs at diagnosis had a shorter OS compared to those with normal LFTs (HR 1.80 95% CI 1.13-2.87; P =.014, adjusted for age, sex, Rai stage, and treatment), although TTFT was not different. Of 52 patients who underwent a liver biopsy, CLL was present in liver tissue in 39/52 (73%) patients, with the portal tracts the most common region involved. Histopathology findings of liver involvement by CLL had limited correlation with choice of CLL therapy. In conclusion, approximately 1 of 25 newly diagnosed CLL patients has abnormal LFTs at diagnosis. Although the TTFT was not different among patients with abnormal LFTs, these patients have a shorter OS compared to those with normal LFTs.

Original languageEnglish (US)
Pages (from-to)1362-1369
Number of pages8
JournalAmerican Journal of Hematology
Volume92
Issue number12
DOIs
StatePublished - Dec 1 2017

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B-Cell Chronic Lymphocytic Leukemia
Liver Diseases
Liver Function Tests
Survival
Liver
Therapeutics
Platelet Count
Hemoglobins
Biopsy

ASJC Scopus subject areas

  • Hematology

Cite this

Liver dysfunction in chronic lymphocytic leukemia : Prevalence, outcomes, and pathological findings. / Hampel, Paul J.; Chaffee, Kari G.; King, Rebecca; Simonetto, Douglas; Larson, Melissa C.; Achenbach, Sara; Call, Timothy G.; Ding, Wei D; Kenderian, Saad; Leis, Jose F.; Chanan Khan, Asher A; Bowen, Deborah A.; Conte, Michael J.; Schwager, Susan M.; Hanson, Curtis A.; Slager, Susan L; Kay, Neil Elliot; Shanafelt, Tait D.; Parikh, Sameer A.

In: American Journal of Hematology, Vol. 92, No. 12, 01.12.2017, p. 1362-1369.

Research output: Contribution to journalArticle

Hampel, PJ, Chaffee, KG, King, R, Simonetto, D, Larson, MC, Achenbach, S, Call, TG, Ding, WD, Kenderian, S, Leis, JF, Chanan Khan, AA, Bowen, DA, Conte, MJ, Schwager, SM, Hanson, CA, Slager, SL, Kay, NE, Shanafelt, TD & Parikh, SA 2017, 'Liver dysfunction in chronic lymphocytic leukemia: Prevalence, outcomes, and pathological findings', American Journal of Hematology, vol. 92, no. 12, pp. 1362-1369. https://doi.org/10.1002/ajh.24915
Hampel, Paul J. ; Chaffee, Kari G. ; King, Rebecca ; Simonetto, Douglas ; Larson, Melissa C. ; Achenbach, Sara ; Call, Timothy G. ; Ding, Wei D ; Kenderian, Saad ; Leis, Jose F. ; Chanan Khan, Asher A ; Bowen, Deborah A. ; Conte, Michael J. ; Schwager, Susan M. ; Hanson, Curtis A. ; Slager, Susan L ; Kay, Neil Elliot ; Shanafelt, Tait D. ; Parikh, Sameer A. / Liver dysfunction in chronic lymphocytic leukemia : Prevalence, outcomes, and pathological findings. In: American Journal of Hematology. 2017 ; Vol. 92, No. 12. pp. 1362-1369.
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abstract = "The prevalence of liver dysfunction and its association with outcomes in patients with previously untreated chronic lymphocytic leukemia (CLL) is unknown. Newly diagnosed (<12 months) previously untreated CLL patients seen at Mayo Clinic, Rochester, MN between 9/1993 and 4/2016 who had baseline assessment of at least one liver function test (LFT) were included in this analysis. The prevalence of liver dysfunction at baseline, proportion of patients who acquired LFT abnormalities, time to first therapy (TTFT) and overall survival (OS) were assessed. An abnormal LFT was present in 82/2336 (3.5{\%}) patients at diagnosis and was associated with advanced Rai stage (Rai III–IV) (21{\%} vs. 6{\%}; P <.001), lower hemoglobin (13.1 g/dL vs. 13.9 g/dL; P <.001), and lower platelet count (187 × 109/L vs. 200 × 109/L; P =.03). Additionally, 236 patients with normal LFTs at diagnosis developed acquired liver dysfunction during follow-up. Patients with abnormal LFTs at diagnosis had a shorter OS compared to those with normal LFTs (HR 1.80 95{\%} CI 1.13-2.87; P =.014, adjusted for age, sex, Rai stage, and treatment), although TTFT was not different. Of 52 patients who underwent a liver biopsy, CLL was present in liver tissue in 39/52 (73{\%}) patients, with the portal tracts the most common region involved. Histopathology findings of liver involvement by CLL had limited correlation with choice of CLL therapy. In conclusion, approximately 1 of 25 newly diagnosed CLL patients has abnormal LFTs at diagnosis. Although the TTFT was not different among patients with abnormal LFTs, these patients have a shorter OS compared to those with normal LFTs.",
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AU - Call, Timothy G.

AU - Ding, Wei D

AU - Kenderian, Saad

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AU - Conte, Michael J.

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