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Alert Number 306

Pneumonia - the Alpha and Omega for CLL Patients

Date: November 20, 2008

A couple of years ago we did a very unscientific survey of our members, to see how many of them had a history of pneumonia.  It was suspiciously high.  Of course, the single very anecdotal data point that got me thinking along these lines is that my husband PC had a long and protracted episode of pneumonia just about two years before he was formally diagnosed with CLL. Back then he was a high powered banker who could not take time off for trivial things like pneumonia, and his GP encouraged him by calling it “walking pneumonia” – a euphemism that PC took as permission to keep “walking”. How I wish I had known better back then and nagged him to get prompt treatment for it.

Does prior history of pneumonia increase the risk of getting CLL? Do frequent episodes of pneumonia signal the beginning of immune dysfunction that in a section of the population with other predisposing factors lead to CLL?  The abstract below from the epidemiology group at the National Cancer Institute draws clear connections between pneumonia and CLL.  “Individuals with 3 or more prior pneumonia events had a significant 2.5-fold elevated CLL risk”. This was a large and scientifically conducted study, with more than four thousand patients in it.  Looks like our own unscientific study did not mislead us either.

The other bookend, the thing that makes pneumonia the alpha and omega for CLL, is the fact that more CLL patients die as a result of pneumonia than any other complication. Here is the link to our November 2003 review of the role of pulmonary inflammation in CLL:

Take home messages?  With the winter flu season upon us, don’t make light of chest infections, be aware that a bad case of flu can quickly escalate into full blown pneumonia in immune compromised patients. Your best protection lies in “herd immunity” (where everyone around is protected by flu shots), and “social distancing” in the coming holidays – that means you don’t have to kiss all the ladies, especially if they have the sniffles, the cutest grand kids are germ factories, and you should wash your hands a zillion times anyway.

Just a couple of weeks ago we wrote again about Familial CLL.  People ask me what they can do to protect their kids, what can be done to reduce the risk of CLL in the next generation.  One obvious suggestion: don’t let them do what PC did and ignore a protracted case of “walking” pneumonia.  Teach your kids to recognize pulmonary inflammation for the dangerous thing it is and not ignore it as a trivial case of the sniffles.

Be well,

Blood 2007 Mar 1;109(5):2198-201. Epub 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

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-7236, USA.

Recent evidence suggests that chronic lymphocytic leukemia (CLL) might occur following a response to an infectious agent. We conducted a population-based study including 4249 CLL patients diagnosed in Denmark from 1977 to 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 that listed infections present at least 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 to 4.99 years prior to CLL diagnosis (OR = 1.6; 1.2-2.0). Individuals with 3 or more 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 (P(trend) < .001). None of 9 other respiratory-tract infections was significantly associated with CLL risk. Pneumonia might be a potential CLL trigger or it could represent premalignant immune disruption preceding CLL.

PMID: 17082317

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