A study further characterized the clinical presentation of symptomatic bronchial involvement in patients with chronic lymphocytic leukemia (CLL). The study findings were recently published in the British Journal of Haematology.
The study included 19 patients with CLL who presented with symptomatic bronchial involvement (for whom data were retrospectively collected) and 10 patients with CLL and no bronchial symptoms to serve as the control cohort.
Several characteristics were identified from the CLL cases with symptomatic bronchial involvement. Patients with CLL who had symptomatic bronchial involvement had a significantly higher proportion of anomalies in small airways and peripheral bronchi (P =.001), specifically endobronchial nodules were found in 62% of cases and tree-in-bud pattern in 77% of cases. More than half of cases (54%) also had airflow obstruction. Bronchoscopy revealed visible endobronchial nodules in 4 cases.
From the point of initial diagnosis of CLL, cases were diagnosed with symptomatic bronchial involvement after a median of 61 months (range, 0-288 months) and all but 1 patient received 1 or more line of treatment. Treatment varied among cases: 11 received chemotherapy with rituximab, 2 received chemotherapy alone, 1 received alemtuzumab plus chemotherapy, 3 received ibrutinib, and 1 received venetoclax. Most cases (61%) received first-line treatment when symptomatic bronchial involvement presented.
After treatment, most cases had bronchial improvement, with 82% improving on the clinical level, 92% improving on the radiological level, and 71% improving on the functional level.
“In summary, we report here on the largest cohort of CLL patients with symptomatic and specific bronchial tree infiltration,” the study authors wrote. “Our findings document that [symptomatic bronchial involvement] is a manifestation of CLL that should be considered along with CLL history when a patient presents with an unexplained obstructive respiratory condition.”
Nudel M, Baran‐Marszak F, Bossard J-B, et al. Characterisation of a new clinical presentation of chronic lymphocytic leukaemia: symptomatic bronchial involvement, a study from the FILO group [published online May 22, 2019]. Br J Haematol. doi: 10.1111/bjh.15966