Abnormal Liver Function Associated With Poor Survival in B-Cell Malignancy

10/16/17

Patients with a certain B-cell malignancy and abnormal liver function tests at diagnosis are at risk of shorter overall survival (OS) compared with those who have normal liver function, according to research published in the American Journal of Hematology (online September 22, 2017; doi:10.1002/ajh.24915).

Recent research has shown the clinical and prognostic importance of organ systems—particularly the kidneys and skin—on the survival outcomes of patients with chronic lymphocytic leukemia (CLL). However, limited data exist regarding the prognostic implications of liver dysfunction in this population.

Paul J Hampel, MD, department of internal medicine, Mayo Clinic (Rochester, MN), and colleagues conducted a study to assess the potential relationship between liver dysfunction and OS for patients newly-diagnosed with CLL. A total of 2336 patients with untreated disease between 1993 and 2016 were sampled. Researchers assessed for the prevalence of liver dysfunction at baseline, proportion of patients who acquired liver function test abnormalities, time to first therapy, and OS.  

Eighty-two patients (3.5%) had abnormal liver function tests at baseline. Abnormal liver function test was associated with advanced Rai stage (Rai III-IV), lower hemoglobin, and lower platelet count, researchers reported.

Among the patients without a normal test at baseline, 1594 had a liver function test after diagnosis at a median follow-up of 59 months. After 10 years follow-up, approximately 25% of patients had experienced at least one abnormal liver function test when follow-up was censored at death. In such patients, lower hemoglobin and lower platelet count predicted risk for development of liver dysfunction at subsequent follow-up. Other predicting factors included CD49d expression, CD38 expression, ZAP-70 expression, unmutated IGHV, and high-risk FISH.

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Additionally, 52 patients underwent liver biopsy. Traces of CLL were found in the liver tissue in 73% of these patients. Portal tracts were the most commonly involved region.

Patients with abnormal liver function tests at baseline demonstrated a shorter OS compared with those with normal tests (HR, 1.80; 95% CI, 1.13-2.87; P = .014). Researchers acknowledged that the time to first therapy was comparable between the two groups.

“A plausible theory is that high-risk patients develop more aggressive disease with more extensive liver involvement that results in dysfunction,” researchers wrote. “This may explain the unexpected finding of our study.”—Zachary Bessette