Purpose: Mean platelet volume (MPV) is a readily accessible and commonly tested hematological indicator. Recent studies revealed a significant impact of MPV on the course and prognosis of many diseases, including some types of cancer, as well as on the incidence of atrial fibrillation and bleeding. The study aimed to perform a retrospective analysis of MPV in terms of time to first treatment (TTFT) and to determine its prognostic value in the group of patients with chronic lymphocytic leukemia (CLL). Moreover, the study includes a retrospective analysis of platelet parameters in patients treated with ibrutinib concerning bleeding and atrial fibrillation. Patients and Methods: The study included 523 patients with CLL, for 344 the most important cytogenetic aberrations were reported. The Mann-Whitney, Kruskal-Wallis, Kaplan-Meier, chi-squared, log-rank tests and multivariate Cox proportional hazard regression model were used to analyze collected data. Results: The receiver operating characteristic curve analysis was performed to identify optimal cutoff value for MPV. The analysis of survival curves showed that in the group of patients with higher values of MPV TTFT was significantly longer than in the group with lower MPV (17.9 vs 36 months, p=0.0015, cutoff value for MPV= 10.4 fl). In multivariate Cox proportional hazard regression model low MPV, the presence of del11q and del13q provided independent prognostic value for TTFT (HR=0.69, 95%-CI, 0.5293 to 0.9081; p=0.0078; HR=1.76, 95%-CI, 1.3000 to 2.3882, p=0.0003, HR=0.74, 95%-Cl, 0.5674 to 0.9588, p=0.0229, respectively). In the group treated with ibrutinib, 59 patients had no significant correlation between MPV level and the incidence of therapy complications, although in the group of patients with low MPV there was a tendency for more frequent occurrence of atrial fibrillation (p=0.259). Conclusion: Low MPV values are associated with unfavorable prognosis and might represent a novel, independent prognostic factor in CLL.
Chronic lymphocytic leukemia (CLL) constitutes the most common leukemia in adults living in western countries. The clinical course of the disease is extremely heterogeneous and pathogenesis is still unknown. Immune system disorders in CLL patients are observed in the early stages of the disease and worsen during clinical observation. On the one hand, CLL patients are characterized by immunosupresion and on the other hand, autoimmune processes. The immunosuppression observed in patients with CLL is associated with disorders of non‑specific immune response as well as T‑cell and B‑cell response, leading to frequent and severe infections. The immune system of patients with CLL could be also inhibited by many immunosuppressive factors occurred in tumor microenvironment, including populations of immune cells, which include myeloid‑derived suppressor cells (MDSCs), T regulatory cells (Treg) and the newly described B regulatory cells (Breg). It was shown that CLL cells can regulate immune response and escape from the surveillance of the immune system through the PD‑1/PD‑L signalling pathway. Interestingly, reduced immune response in CLL patients may be accompanied by autoimmune processes clinically manifested as autoimmune cytopenias. The secondary autoimmune cytopenias complicating the course of the disease include autoimmune hemolytic anemia (AIHA), immune thrombocytopenia purpura (ITP), pure red cell aplasia (PRCA) and autoimmune granulocytopenia (AG). Identification of immunological disorders in patients with CLL is necessary to understand the biology of the disease and to select appropriate treatment patterns based on modulation of the immune system.
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