Prevention and treatment of complications of chronic lymhocytic leukemia (Case presentation)

BACKGROUND Infections, autoimmune complications and secondary cancers are the most frequent complications of chronic lymphocytic leukemia (CLL) . All are the result of modified immune system. The causes of attenuated humoral and cellular immunity lay in the qualitative and quantitative defects of B and T lymphocytes, as well as of neutrophils and monocytes/ macrophages. CASE REPORT A patient with CLL is shown, in whom autoimmune hemolytic anemia (AIHA) was found at the time of respiratory infection . The patient was succesfully treated with steroids, intravenous immunoglobulins (IVIG), antibiotics and blood transfusions. Some years later, having respiratory infection and AIHA again , he was treated in the same way, but had side effects after steroid therapy. So he was succesfully treated with rituximab. Because of hypogammaglobulinaemia and repeated colds without worsening of AIHA he was receiving prophylactic IVIG monthly. He has been in remission for a couple of years now without AIHA , but in the last time he underwent surgery for renal and skin carcinoma. CONCLUSIONS Among autoimmune complications, AIHA and immune thrombocytopenia (IT) are most frequent. The treatment is based on supportive care, corticosteroids, IVIG, splenectomy, and in last years also on monoclonal antibodies. Hypogammaglobulinemia is present in virtually all patients with consequent frequent and serious infections. In this group of patients prophylactic use of IVIG is recommended, but it does not reduce mortality. Vaccination is useful if used in earlier stages of CLL.