Immune Defects and Baseline Infection Risk Assessment in CLL

Marc J. Braunstein, MD, PhD, of NYU Grossman Long Island School of Medicine, walks Danielle M. Brander, MD, of Duke University School of Medicine, through the immune defects intrinsic to chronic lymphocytic leukemia (CLL). As a B-cell malignancy, CLL impairs innate immunity, including natural killer cell, macrophage, and neutrophil function, and adaptive immunity, with hypogammaglobulinemia often present at baseline and worsened by anti-CD20 antibodies; regulatory T cells and myeloid-derived suppressor cells in the tumor microenvironment further dampen immune responses. Asked what he checks at baseline, Dr Braunstein describes routine blood counts, quantitative immunoglobulins, hepatitis and HIV testing, and vaccine titers rather than T-cell subsets. Dr Brander adds that immune function varies widely between patients with CLL and that baseline immunoglobulin levels help quantify that heterogeneity before therapy starts. Both emphasize vaccination, and Dr Brander notes patients are often missing pneumococcal, recombinant zoster, and annual influenza vaccines that may still offer partial protection.