Work

Clinical characteristics and outcome of CLL/SLL patients with renal involvement in the era of targeted drugs

Year: 2026

Type: article

Abstract: Background Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) is a clonal mature B-cell neoplasm with rare extranodal organ renal involvement. Objectives To summarize the clinical and pathological characteristics of biopsy-confirmed CLL/SLL-associated renal lesions and evaluate the efficacy of targeted combination therapy. Design Retrospective multicenter observational study. Methods Eleven patients with CLL/SLL-associated nephropathy were enrolled from January 2017 to October 2024 across three Chinese centers. As of December 31, 2025, data were collected through electronic medical records and telephone follow-up. Results The median age was 58 (range 40–72) years. Among tested patients, 88.9% (8/9) exhibited IGHV mutation and 62.5% (5/8) were CLL-IPI low-risk, and no TP53 mutations were detected. The median time from CLL diagnosis to renal biopsy was 40.7 months (range: 0.2–58 months). Biopsy indictions included proteinuria (90.9%, 10/11), hematuria (54.5%, 6/11), renal dysfunction (54.5%, 6/11), and nephrotic syndrome (9.1%, 1/11). Main pathologies were tumor cell interstitial infiltration (45.5%, 5/11), membranoproliferative glomerulonephritis (27.3%, 3/11), membranous nephropathy (18.2%, 2/11), and C3 glomerulonephritis (9.1%, 1/11). Concomitant monoclonal gammopathy and cryoglobulinemia were observed in 27.3% and 18.2%, respectively. Nine patients received BTKi -based therapy. The best overall response rate (ORR) for CLL/SLL was 100%, with a CR rate of 72.7%. According to KDIGO 2021 guidelines, the renal best ORR was 100%, with a CR rate of 36.4%. Four patients achieved CR in both CLL and renal assessments. As of December 31, 2025, the median follow-up was 70.1 months and median PFS was not reached. Grade ≥3 hematologic toxicities included neutropenia (27.3%) and thrombocytopenia (18.2%). Common non-hematologic adverse events were COVID-19 (27.3%), bleeding (18.2%), and gastrointestinal symptoms (18.2%), all of grade 1-2. Conclusions CLL/SLL with renal involvement is associated with a favorable IGHV-mutated profile. Interstitial infiltration and membranoproliferative glomerulonephritis are the predominant renal pathologies. BTKi-based regimens were associated with favorable hematologic and renal outcomes in this small cohort.

Source: Therapeutic Advances in Hematology

DOI: 10.1177/20406207261501030