Prognostic significance of baseline liver enzyme patterns in chronic lymphocytic leukemia: a nationwide real-world cohort study

Liver biochemical abnormalities are relatively common at chronic lymphocytic leukemia (CLL) diagnosis, but their prognostic significance is unclear. We conducted a nationwide real-world study of 3448 adults with newly diagnosed CLL in Clalit Health Services, Israel, with liver biochemistry assessed within ±3 months of diagnosis and no documented preexisting liver disease. Cholestatic elevation was defined as elevated alkaline phosphatase and/or gamma-glutamyl transferase; hepatocellular elevation as elevated alanine and/or aspartate aminotransferase. Median follow-up was 74.9 months. Cholestatic and hepatocellular elevations were present in 16.4% and 6.0% of patients, respectively. In multivariable Cox models, cholestatic elevation was independently associated with inferior overall survival (hazard ratio (HR), 1.21; 95% CI, 1.05–1.39; p = 0.008), whereas hepatocellular elevation did not. Neither pattern was independently associated with time to first treatment. Cholestatic elevation was also associated with increased infection-related hospitalization rates and hospitalized days, identifying a clinically vulnerable subgroup at CLL diagnosis.