Should a positive direct antiglobulin test be considered a prognostic predictor in chronic lymphocytic leukemia?

Background: The clinical course of patients with B-cell CLL is often complicated by autoimmune phenomena. The DAT might be positive at some time during the course of the disease in up to 35% of cases. The aim of this retrospective study was to investigate the relationship between the occurrence of a positive DAT and biological features of CLL patients. Patients and Methods: In our institution, 146 untreated patients with CLL were studied using the DAT. Results: According to the statistical analysis, a high level of β2-microglobulin and unmutated IgHV emerged as factors significantly related to the presence of DAT positivity. Time to first TFS was significantly shorter in DAT-positive patients. The adverse effect of a DAT positive result was maintained in terms of TFS when patients with mutated IgHV status were excluded from statistical analysis. Conclusion: These results suggest that the DAT might provide additional prognostic information regarding patients with IgHV unmutated status.