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Alert Number 198

Respiratory Infections

Date: November 8, 2006

We have hammered the point that respiratory tract infections in general, and pneumonia in particular, are responsible for majority of hospitalizations and even death in CLL patients. You are well advised to take sinus and chest infections seriously, a warning that is timely as the annual flu season approaches.

Chicken and Egg

Below is the abstract of a brand new article in “Blood”, which raises the sequencing question of chicken and egg. Which came first?

The authors report a retrospective study of around four thousand CLL patients in Denmark, over a 20 year period. They noticed that people who have had pneumonia were 40% more likely to be diagnosed with CLL in the next 1-5 years, and for those that had more than 3 episodes of pneumonia the risk of developing CLL was even higher, 2.5 fold higher.

There are two possible explanations for this intriguing result. First, it may be that we are closing in on an infectious agent that is responsible for causing CLL. This would not be all that outlandish, we now know of many cancers that are driven by a variety of pathogens, including chemicals and viral agents. The second possible explanation is that people who are immune-compromised in some way are more likely to get pneumonia — and they are also more likely to develop full-fledged cancer of the immune system, namely CLL, over time.

In any case, this study drives home once more the connection between CLL and pneumonia. Independent of which came first, the CLL or the pneumonia, it is clear that CLL patients need to be very careful about controlling respiratory tract infections. As the mother of a much beloved daughter, it also makes me more vigilant in watching out for chronic respiratory infections in her. As we pointed out in our article on familial CLL, the worst day in the lives of parents is when/if we find out our kids are next in line for this awful disease.

Not the worst day of your life;
Chronic inflammation and what you can do about it;
Chronic Pulmonary Inflammation.

Be well,



Blood. 2006 Nov 2.

Respiratory tract infections and subsequent risk of chronic lymphocytic leukemia.

Landgren O, Rapkin JS, Caporaso NE, Mellemkjaer L, Gridley G, Goldin LR, Engels EA.

National Cancer Institute.

Recent evidence suggests that chronic lymphocytic leukemia (CLL) might occur following a response to an infectious agent. We conducted a population-based study including 4,249 CLL patients diagnosed in Denmark 1977-1997 and 15,690 frequency matched controls to quantify risk of CLL following various airway infections. Through data linkage we gathered information on hospital inpatient/outpatient discharges listing infections present >/=1 year prior to CLL. Using logistic regression, we calculated odds ratios (ORs) and 95% confidence intervals (CIs). Personal history of pneumonia was associated with significantly increased CLL risk (OR=1.4;1.2-1.8); risk was restricted to 1-4.99 years prior to CLL diagnosis (OR=1.6;1.2-2.0). Individuals with 3+ prior pneumonia events had a significant 2.5-fold (1.1-5.6) elevated CLL risk, and risk increased with the number of pneumonia episodes (ptrend<0.0001). None of nine other respiratory tract infections was significantly associated with CLL risk. Pneumonia might be a potential CLL trigger, or it could represent pre-malignant immune disruption preceding CLL

PMID: 17082317

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