| Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc |
| Journal website http://www.thejh.org |
Case Report
Volume 7, Number 1, January 2018, pages 14-18
Chylothorax in Patients With Chronic Lymphocytic Leukemia: A Case Series
Tables
| Patient | Age at presentation of chylothorax/sex | Cytogenetics | IGHV status | Other prognostic markers | Treatments | Symptoms | Outcome |
|---|---|---|---|---|---|---|---|
| IGHV: immunoglobulin heavy chain variable region genes; RT: radiation therapy. | |||||||
| Patient 1 | 78/M | 13q deletion | Unmutated | CD38 (-); Zap70 (-) | Interferon; cladribine; pentostatin, cyclophosphamide and rituximab; bendamustine and rituximab | Shortness of breath | Bendamustine and Rituxan × two cycles: developed recurrent effusions 2 years post therapy; ibrutinib: tolerated for 5 months with good response before developing atrial fibrillation; PleurX catheterization; obinutuzumab with ibrutinib: approximately 5 months with therapy complicated by atrial fibrilation and bloody pleural effusions; idelalisib: tolerated for 3 weeks and discontinued due to grade III psoriatic type rash; ibrutinib was re-challenged but due to recurrent infection and effusions, he elected for home hospice. |
| Patient 2 | 81/F | 11q deletion | Unknown | CD38 (+) | Bendamustine and Rituxan | Shortness of breath | Marginal improvement after bendamustine and Rituxan (three cycles) developed worsening chylous effusions and deferred further therapy and expired due to pulmonary complications |
| Patient 3 | 77/F | 13q deletion | Mutated | CD38 (-) | Obintuzumab × 1 cycle; 2,400 cGy RT | Shortness of breath | Improved after 2,400 cGy to thoracic duct and mediastinum |
| Patient | Color | Pleural fluid nucleated cell count (cell/µL) | Pleural fluid RBC count (cell/µL) | Pleural fluid glucose | Fluid/serum protein | Fluid/serum albumin | Fluid/serum LDH | Pleural fluid triglycerides |
|---|---|---|---|---|---|---|---|---|
| RBC: red blood cell; LDH: lactate dehydrogenase. | ||||||||
| Patient 1 | Yellow, cloudy | 120 | 8,875 | 112 | 3.3/5.8 | 2.8/4.2 | 122/194 | 347 |
| Patient 2 | Cream colored, turbid | 210 | 860 | 236 | 5.1/6.5 | 2.9/3.2 | 147/275 | n/a |
| Patient 3 | Cream colored | n/a | n/a | 113 | 2.2/4.5 | 1.6/3.1 | 319/415 | 311 |