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The neurologic complications of B-cell chronic lymphocytic leukemia
J H Bower1, J E Hammack, S K McDonnell
1Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Insights
Neurologic complications in B-cell chronic lymphocytic leukemia (B-CLL) are uncommon, with herpes zoster being the most frequent. Disease stage significantly impacts the risk of these complications.
Area of Science:
- Neurology
- Hematology
- Oncology
Background:
- B-cell chronic lymphocytic leukemia (B-CLL) is a common B-cell malignancy.
- Neurologic complications can affect patients with B-CLL, impacting quality of life and prognosis.
- Understanding the spectrum and risk factors for these complications is crucial for patient management.
Purpose of the Study:
- To characterize the types, frequency, and timing of neurologic complications in B-CLL patients.
- To identify correlations between B-CLL stage and the occurrence of neurologic complications.
- To provide insights into the risk stratification for neurologic events in B-CLL.
Main Methods:
- Retrospective chart review of 962 patients diagnosed with B-cell chronic lymphocytic leukemia.
- Analysis of neurologic complication types, including infections, treatment-related events, and direct leukemic involvement.
- Evaluation of complication occurrence in relation to disease stage (Rai staging) and time from diagnosis.
Main Results:
- A total of 109 neurologic complications (11.3%) were identified in 962 patients.
- Herpes zoster infection was the most common complication (7.2%), followed by other opportunistic infections (1.8%) and treatment-related conditions (1.5%).
- Early-stage B-CLL (Rai 0-2) showed a low incidence of non-zoster opportunistic infections and direct leukemic involvement.
Conclusions:
- The overall rate of neurologic complications in B-CLL is low.
- Rai stage is the most significant factor correlating with the risk of neurologic complications.
- The risk of non-zoster neurologic complications in early-stage B-CLL is approximately 1 in 1,000.
Abstract:
We performed a retrospective study to characterize the type, frequency, and timing of neurologic complications in patients with B-cell chronic lymphocytic leukemia (B-CLL). We reviewed 962 total charts with a median follow-up time of 57.5 months. There were 109 cases (11.3%) of neurologic complications, including 69 cases (7.2%) of herpes zoster infection, 17 cases (1.8%) of other opportunistic infection, 14 cases (1.5%) of treatment-related conditions, eight cases (0.8%) of direct leukemic involvement of neural tissue, and 1 case (0.1%) of intracranial hemorrhage. No cases of a non-zoster opportunistic infection presented in early-stage (Rai stage 0-2) B-CLL, and only one case of direct leukemic involvement of neural structures presented in early-stage B-CLL. Of the 25 cases of non-zoster or treatment-related complications, only 5 presented before 6 years from the initial B-CLL diagnosis. Three of these were in advanced-stage B-CLL, staging could not be determined in one, and one presented in early-stage B-CLL. We conclude that the overall neurologic complication rate of B-CLL is low, and that the Rai stage of the disease correlates best with the risk of developing neurologic complications. The occurrence of a related non-zoster neurologic complication in a patient with B-CLL stage 0-2 approaches 1:1,000.