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Published on: July 20, 2016
Prognostic significance of baseline liver enzyme patterns in chronic lymphocytic leukemia: a nationwide real-world
Yotam Bronstein1,2, Lior Rokach3, Yair Herishanu1,2
1Hematology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Insights
Liver biochemical abnormalities are common in chronic lymphocytic leukemia (CLL). Cholestatic elevation, but not hepatocellular, is linked to poorer survival and increased infection risk in CLL patients.
Area of Science:
- Hematology
- Hepatology
- Oncology
Background:
- Liver biochemical abnormalities are frequently observed in patients diagnosed with chronic lymphocytic leukemia (CLL).
- The prognostic implications of these liver abnormalities at the time of CLL diagnosis remain incompletely understood.
- Existing research has not clearly defined the impact of specific patterns of liver enzyme elevation on patient outcomes.
Purpose of the Study:
- To investigate the prognostic significance of liver biochemical abnormalities in newly diagnosed chronic lymphocytic leukemia (CLL) patients.
- To determine the association between cholestatic and hepatocellular elevations and overall survival, time to treatment, and infection-related hospitalizations.
- To identify specific subgroups of CLL patients who may be at higher risk due to liver involvement.
Main Methods:
- A nationwide real-world study involving 3448 adults with newly diagnosed CLL in Israel.
- Liver biochemistry was assessed within three months of diagnosis, excluding patients with pre-existing liver disease.
- Cholestatic elevation defined by alkaline phosphatase/gamma-glutamyl transferase; hepatocellular by alanine/aspartate aminotransferase. Multivariable Cox models were used for analysis.
Main Results:
- Cholestatic and hepatocellular elevations were present in 16.4% and 6.0% of patients, respectively.
- Cholestatic elevation was independently associated with inferior overall survival (HR, 1.21; p=0.008).
- Neither pattern was associated with time to first treatment, but cholestatic elevation correlated with increased infection-related hospitalizations.
Conclusions:
- Cholestatic liver biochemical elevation at diagnosis is an independent predictor of inferior overall survival in chronic lymphocytic leukemia (CLL).
- This finding identifies a clinically vulnerable subgroup of CLL patients requiring closer monitoring for infections.
- Hepatocellular elevation did not show a significant association with survival or treatment initiation in this cohort.
Abstract:
Liver biochemical abnormalities are relatively common at chronic lymphocytic leukemia (CLL) diagnosis, but their prognostic significance is unclear. We conducted a nationwide real-world study of 3448 adults with newly diagnosed CLL in Clalit Health Services, Israel, with liver biochemistry assessed within ±3 months of diagnosis and no documented preexisting liver disease. Cholestatic elevation was defined as elevated alkaline phosphatase and/or gamma-glutamyl transferase; hepatocellular elevation as elevated alanine and/or aspartate aminotransferase. Median follow-up was 74.9 months. Cholestatic and hepatocellular elevations were present in 16.4% and 6.0% of patients, respectively. In multivariable Cox models, cholestatic elevation was independently associated with inferior overall survival (hazard ratio (HR), 1.21; 95% CI, 1.05-1.39; p = 0.008), whereas hepatocellular elevation did not. Neither pattern was independently associated with time to first treatment. Cholestatic elevation was also associated with increased infection-related hospitalization rates and hospitalized days, identifying a clinically vulnerable subgroup at CLL diagnosis.
