Serious bronchopulmonary involvement due to chronic lymphocytic leukaemia

Abstract

References Serious bronchopulmonary involvement due to chronic lymphocytic leukaemiaTo the Editor:Chronic lymphocytic leukaemia (CLL) is the most common type of leukaemia, accounting for 40% of all cases in individuals .65 years of age. Thoracic complications of CLL can be classified into three groups: 1) infectious complications, which are by far the most frequent and are directly related to the severity of immunodeficiency secondary either to leukaemia or therapy; 2) pleural effusions that are either in CLL localisation or related to venous or lymphatic compression caused by a mass or lymph node, and 3) specific bronchopulmonary involvement secondary to lymphocytic infiltration.Specific bronchopulmonary involvement due to chronic lymphocytic leukaemia (or pathologic leukaemic bronchopulmonary infiltration (LBPI)) is rare and there are few reports in the literature. We report the cases of six patients with CLL and bronchopulmonary leukaemic infiltrates who needed specific treatment due to the severity of respiratory symptoms.

Pulmonary Leukaemic Infiltration in Patient with Chronic Lymphocytic Leukaemia

“…KLL'de torasik komplikasyonlar 3 başlık altında incelenebilir: 1) Doğrudan lösemi şiddetiyle veya tedaviye sekonder immün yetmezlik ile ilişkili olan enfeksiyöz komplikasyonlar, 2) KLL'nin lokalizasyonuyla ilgili olarak bir kitle veya lenf düğümünün neden olduğu venöz veya lenfatik kompresyona bağlı plevral efüzyonlar ve 3) Lenfositik infiltrasyona sekonder bronkopulmoner tutulum (6). KLL nedeniyle spesifik bronkopulmoner tutulum [Patolojik bronkopulmoner lösemik infiltrasyon (BPLI)] nadirdir ve çok az sayıda olgu literatürde bildirilmiştir.…”

“…BPLI'yi destekleyen semptom ve radyolojik bulgular pnömoniyi taklit etmekte ve çoğu olguda kesin tanıdan önce antibiyotik kullanım öyküsü bulunmaktadır. KLL ve bronkopulmoner lösemik infiltrat bulunan altı hastanın bildirildiği bir seride olguların 5'inde pnömoni öyküsünün olduğu ve sadece 1 olgunun daha önce spesifik KLL tedavisi almadığı gözlenmiştir ve 6 olgunun tümünün median 6 aydır (1 ay -3 yıl) remisyonda olduğu saptanmıştır (6). Uygun poliantibiyotik tedaviye rağmen olgularda öksürük, ateş ve dispne semptomları gözlenebilir.…”

“…BPLI'nin radyolojik görünümleri non-spesifiktir (9). Toraks BT'de multipl bilateral mediastinal LAP, mozaik perfüzyon, ekspiratuvar hava hapsi, sentrilobüler mikronodüller ile tomurcuklanmış ağaç manzarası, sentrilobüler buzlu cam opasiteleri veya homojen parankimal konsolidasyon izlenebilir (6,(13)(14)(15). Bazen lenfositlerle bronşiyal infiltrasyon veya tekrarlayan enfeksiyonlar sonucunda santral bronşektaziler gelişebilir (16,17).…”

Characterisation of a new clinical presentation of chronic lymphocytic leukaemia: symptomatic bronchial involvement, a study from the FILO group

“…Patients with chronic lymphocytic leukaemia (CLL) frequently present with pulmonary injuries (Khanijo et al , ), such as infections that include bacterial and pneumocystis pneumonia or invasive aspergillosis (Henn et al , ). Lungs may also be the site of leukaemic pulmonary infiltration – an extra‐nodal development of the disease – in the pulmonary parenchyma (Hill et al , ; Carmier et al , ). Although a few cases of symptomatic bronchial involvement (SBi) associated with CLL (CLL SBi) have been reported, they were mostly from the pre‐rituximab era (Chernoff et al , ; Palosaari & Colby, ; Desjardins et al , ; Maw et al , ).…”

Deferasirox in the management of iron‐overload in patients with myelofibrosis: a multicentre study from the Rete Ematologica Lombarda (IRON‐M study)

“…Patients with chronic lymphocytic leukaemia (CLL) frequently present with pulmonary injuries (Khanijo et al, 2017), such as infections that include bacterial and pneumocystis pneumonia or invasive aspergillosis (Henn et al, 2014). Lungs may also be the site of leukaemic pulmonary infiltrationan extra-nodal development of the diseasein the pulmonary parenchyma (Hill et al, 2012;Carmier et al, 2013). Although a few cases of symptomatic bronchial involvement (SBi) associated with CLL (CLL SBi) have been reported, they were mostly from the pre-rituximab era (Chernoff et al, 1984;Palosaari & Colby, 1986;Desjardins et al, 1990;Maw et al, 2015).…”