Patients with chronic lymphocytic leukemia (CLL) hospitalized for immune thrombocytopenia (ITP) were more likely to require intravenous immunoglobulin (IVIG) than steroids as therapy for ITP, according to study results published in conjunction with the 2019 ASCO Annual Meeting.

“[Steroids and IVIG] are considered as the first line of therapy in immune thrombocytopenia (ITP) when treatment is indicated. Approximately 5% of patients with untreated CLL and 25-30% of patients with previously treated CLL have thrombocytopenia,” explained Suheil Albert Atallah-Yunes, MD, University of Massachusetts-Baystate, Springfield, and colleagues.

“There is limited data about ITP treatment patterns and therapeutic responses in patients with CLL,” Dr Atallah-Yunes and colleagues added.

This led the investigators to conduct a retrospective cohort study of adults hospitalized for ITP with CLL as a secondary diagnosis based on ICD-10 codes, using the 2016 National Inpatient Sample.

The primary outcomes were rate of IVIG administration, splenectomy, platelet transfusion, and packed red blood cell transfusion during the same admission. A secondary outcome was length of hospital stay.

Of 14,490 patients hospitalized for ITP, 255 had CLL. There was a significant increase in the use of IVIG among patients with CLL and ITP on multivariate linear regression (odds ratio [OR], 2.11; 95% CI, 1.05-4.23; P=.03).

There were no statistical differences in rate of splenectomy rate (OR, 0.35; 95% CI, 0.05-2.52; P=.28), platelet transfusion (OR, 1.15; 95% CI, 0.63-2.08; P=.65), or packed red blood cell transfusion (OR, 1.03; 95% CI, 0.44-2.39; P=.94) observed between patients with and without CLL. There was also no statistical difference in length of hospitalization between these patient groups.

“Patients hospitalized for ITP with CLL were more likely to require IVIGs. This could be explained by several theories including the need for a more rapid increase in platelet count as thrombocytopenia may be more severe due to bone marrow infiltration by CLL, immune dysfunction and/or treatment induced thrombocytopenia,” Dr Atallah-Yunes and colleagues concluded.

“CLL patients can have hypogammaglobinemia making them more likely to get IVIG as a treatment of choice for ITP and as an immune replacement. Also, ITP patients with CLL may have less response to steroids, as was noted in a previous study. Fear of atypical infections due to steroids in CLL patients may result in increased IVIG use,” they added.—Janelle Bradley