Complications of chronic lymphocytic leukemia

- MC are infection, anemia, thrombocytopenia

- Life-threatening are leukostasis, tumor lysis syndrome, second cancers
Acute
Infection (due to hypogammaglobulinemia)
o risk increases with disease stage
o can be cause of mortality for up to 50% of patients
o tx can affect which organisms infected with
purine analogs (fludrabine) listeria, mycobacterial spp, Nocardia, Candida,
Aspergillus, Cryptococcus, herpes viruses, Pneumocystis jirovecii
akylator-based regimens (chlorambucil) respiratory tract infx with S.
aureus, S. pneumonia, H influenza, E coli, K pneumonia, Pseudomonas
alemtuzumab herpes viruses, candida, aspergillus, pneumocystic jirovecii
rituximab reactivation of hep B/hep C
o IVIG reserved for recurrent, severe infections (to restore IgG levels)

Anemia
o Causes include GI bleed 2/2 corticosteroid use, thrombocytopenia, mucositis,
coagulopathy; Hypersplenism; Marrow suppression 2/2 to chemotherapy;
Hemolytic anemia; Red blood cell aplasia
o Autoimmune hemolytic anemia dx with decrease in Hb, positive Coombs test,
indirect hyperbilirubinemia, reticulocytosis, elevated LDH
o Red cell aplasia decrease in absolute reticulocyte count due to the loss of red cell
precursors from the bone marrow. Dx with peripheral blood smear and bone
marrow bx. Tx = red cell transfusions and immunosuppressants

Thrombocytopenia
o ITP: rapid, unexplained decrease in platelets when no presence of bone marrow
failure or hypersplenism
o Hypersplenism tx with splenectomy platelet count will improve and need for
platelet transfusion will decrease
Leukostasis medical emergency due to extremely elevated WBC (usually
>400,000/microL) and decreased perfusion
Tumor lysis syndrome
o oncologic emergency
o hyperphosphatemia, hypocalcemia, hyperkalemia, hyperuricemia, renal
insufficiency
o allopurinol and aggressive hydration can be used as prophylaxis prior to
chemotherapy

Chronic
Richters transformation (CLL transforms into aggressive large-cell lymphoma or
prolymphocytic leukemia)
May develop acute myeloid leukemia
May have increase risk of developing other cancers (common are GI, lung, skin)