Pulmonary Complications of Chronic Lymphocytic Leukemia

Abstract

PURPOSE: To characterize the pulmonary manifestations of CLL and the complications secondary to its treatment and to identify the clinical variables associated with morbidity and mortality. We also study the epidemiological, clinical and pharmacological trends in CLL by comparing current data with a previous study conducted by our institution in the last decade. METHODS: A retrospective chart review was performed on 75 consecutive inpatients at a CLL referral center. All patients had a diagnosis code of CLL and pulmonary diseases. The data was analyzed for frequency of specific pulmonary manifestations. The risk factors for mortality were analyzed using the Fisher's exact test and Mann-Whitney test. RESULTS: The mean age of patients at admission was 74.8 yrs; 86% had a high RAI score. 61% were male. Fludarabine, Cyclophosphamide and Rituxan was the most common treatment regimen. Cough and dyspnea (74%) were frequent admission complaints. Pneumonia was the most prevalent diagnosis on admission (66%). Pseudomonas, followed by Pneumocystis, were the typical organism identified (35%, 18%, respectively) in those with pneumonia, compared with the previous decade when it was Staphylococcus aureus. In the previous study, PCP was then seen only in 2 of 110 patients. The most common non infectious complication was pleural effusion, seen in 22 patients (30%). In 13(60%) patients, the effusion was consistent with a hydrostatic cause. In 9(40%) patients the effusion was directly related to CLL. A high BUN, RAI score and a low ANC independently predicted mortality CONCLUSIONS: Pulmonary complications related to CLL are common and are changing secondary to both the chemotherapeutic / biologic treatments and emergence of resistant organisms. A high BUN, RAI score and low ANC act as biomarkers for prediction of mortality. CLINICAL IMPLICATIONS: Newer regimens to treat CLL, including biological therapies, coupled with intrinsic immuno dysregulation, predispose these patients to numerous infections. Recognition of independent variables for mortality and causative organisms may help in management of these patients by allowing the appropriate prophylactic, diagnostic, and therapeutic measures to identify and treat these complications.