Disease-related hypocholesterolemia in patients with hairy cell leukemia. Positive correlation with spleen size but not with tumor cell burden or low density lipoprotein receptor activity.

BACKGROUND

Hypocholesterolemia is common in patients with various malignant diseases, and may be a risk factor for the development or a consequence of the tumor, by different possible mechanisms.

METHODS

Serum lipids were analyzed in 66 patients with symptomatic hairy cell leukemia (HCL) before and repeatedly after treatment with cladribine. Low density lipoprotein (LDL) receptor activity of hairy cells from 12 patients was analyzed.

RESULTS

The median pretreatment serum cholesterol was 4.78 mmol/l. Total cholesterol, LDL cholesterol, and triglycerides were inversely correlated with the spleen size, but not with other markers of tumor burden. High density lipoprotein (HDL) cholesterol correlated to serum beta 2-microglobulin. Anemia and hypocholesterolemia developed synchronously before diagnosis in one patient. After cladribine therapy, there was a highly significant increase in all serum lipids. Low density lipoprotein receptor activity of HCL cells was elevated in only one of 12 patients; this patient had high serum cholesterol. Hypocholesterolemia predicted posttreatment neutropenic fever.

CONCLUSION

Hypocholesterolemia is a common disease-related finding in HCL, which is not caused by an increased LDL receptor activity of leukemia cells, but related to spleen size, predicts posttreatment fever, and is completely reverted after successful treatment of leukemia.