Severe immune thrombocytopenia in chronic lymphocytic leukemia (CLL)

Severe immune thrombocytopenia (ITP) is a frequently associated hematologic condition in CLL with low frequency in the earlier stages of the disease. The aim of the study was to correlate of severe ITP (platelet count <30x109/L) evidence in the earlier CLL stages with biological features, phenotypic and cytogenetic abnormalities and disease outcome. Twelve of 175 (6.9%) diagnosed CLL patients were with severe ITP. The ITP occurrence was significantly associated with ZAP-70 positivity (58%, p=0.028). CD38 and P53 expressions was significantly higher (p=0.038 and p=0.013, respectively) than in CLL without ITP. Based on available FISH data, we found that among 12 cases with deletion of (11) (q22-23) region only one (9%) developed ITP. There was no statistical significance between ITP and cytogenetic deletion (13) (q14). The median overall survival of severe ITP patients was significantly shorter -68.6 months (p=0.016) than the other patients -111 months and overall survival dropped rapidly and was in stable rate after 12 months since the diagnosis. ITP cases had an increased risk of disease progression and mortality risk over 3 fold above the patients without ITP (p<0.001, p<0.05, respectively). Severe ITP patients showed shorter median free of treatment period-2.08 months, compared to CLL without ITP-45.10 months. Severe ITP is associated with a higher frequency of poor prognostic markers such CD38, ZAP-70 and P53 expressions and shortened free of treatment period and overall survival.