---
title: "Incidence and Impact of ALC-only Progression in Chronic Lymphocytic Leukemia"
id: "pubmed-42466974"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42466974"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42466974/"
doi: "10.1182/bloodadvances.2026020680"
published_at: "2026-09-22T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Incidence and Impact of ALC-only Progression in Chronic Lymphocytic Leukemia
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42466974
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42466974/)
- **DOI:** [10.1182/bloodadvances.2026020680](https://doi.org/10.1182%2Fbloodadvances.2026020680)
- **Published At:** 2026-09-22T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The study examined the incidence and clinical consequences of **absolute lymphocyte count (ALC)–only progression** (ALC PD) in chronic lymphocytic leukemia/small lymphocytic lymphoma (**CLL/SLL**) treated in the modern era. - It retrospectively reviewed 339 consecutive patients treated from 2016 to 2025 at the University of Washington/Fred Hutchinson Cancer Center. - Frontline therapies included continuous **Bruton tyrosine kinase inhibitors (BTKi)** (n = 179), bendamustine‑rituximab (**BR**) (n = 66), and time‑limited **BCL2 inhibitors (BCL2i)** (n = 94). - The **cumulative incidence of ALC PD** was higher after BR than after BTKi or BCL2i (P = .021). - Across all treatment groups, **overall survival (OS) from progression** was longer for patients with ALC PD than for those with other forms of progression (median 116 vs 71 months; P = .0012; HR 3.15; 95% CI, 1.52–6.53), with estimated 5‑year OS rates of 83% versus 56%. - Time to next treatment and other outcome details were referenced but the abstract text provided was truncated and specific values or analyses were not reported in the source excerpt. - Full methodological details, additional subgroup analyses, and complete outcome data were not reported in the provided source text.
## Clinical Analysis & Structured Key Points
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](https://pubmed.ncbi.nlm.nih.gov/42466974/#grants) * [ LinkOut - more resources ](https://pubmed.ncbi.nlm.nih.gov/42466974/#linkout) Title & authors Abstract Similar articles MeSH terms Related information Grants and funding LinkOut - more resources Blood Adv Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Blood+Adv%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Blood+Adv%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42466974/) . 2026 Sep 22;10(18):6291-6298. doi: 10.1182/bloodadvances.2026020680. # Incidence and clinical impact of absolute lymphocyte count-only progression in chronic lymphocytic leukemia [Xiancheng Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+X&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Mazyar Shadman](https://pubmed.ncbi.nlm.nih.gov/?term=Shadman+M&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Jenna Voutsinas](https://pubmed.ncbi.nlm.nih.gov/?term=Voutsinas+J&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA."), [Daniel S Hippe](https://pubmed.ncbi.nlm.nih.gov/?term=Hippe+DS&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA."), [Timothy W Randolph](https://pubmed.ncbi.nlm.nih.gov/?term=Randolph+TW&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA."), [Chaitra S Ujjani](https://pubmed.ncbi.nlm.nih.gov/?term=Ujjani+CS&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Christine Crider](https://pubmed.ncbi.nlm.nih.gov/?term=Crider+C&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA."), [Sara Keshmiri](https://pubmed.ncbi.nlm.nih.gov/?term=Keshmiri+S&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA."), [Stephen D Smith](https://pubmed.ncbi.nlm.nih.gov/?term=Smith+SD&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Ryan C Lynch](https://pubmed.ncbi.nlm.nih.gov/?term=Lynch+RC&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Mengyang Di](https://pubmed.ncbi.nlm.nih.gov/?term=Di+M&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Jennifer J Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+JJ&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Paul S Martin](https://pubmed.ncbi.nlm.nih.gov/?term=Martin+PS&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Brian G Till](https://pubmed.ncbi.nlm.nih.gov/?term=Till+BG&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Ajay K Gopal](https://pubmed.ncbi.nlm.nih.gov/?term=Gopal+AK&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#full-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA.") Affiliations Expand ### Affiliations * 1 Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA. * 2 Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA. * PMID: **42466974** * DOI: [ 10.1182/bloodadvances.2026020680 ](https://doi.org/10.1182/bloodadvances.2026020680) Free article Item in Clipboard # Incidence and clinical impact of absolute lymphocyte count-only progression in chronic lymphocytic leukemia Xiancheng Wu et al. Blood Adv. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Blood Adv Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Blood+Adv%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Blood+Adv%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42466974/) . 2026 Sep 22;10(18):6291-6298. doi: 10.1182/bloodadvances.2026020680. ### Authors [Xiancheng Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+X&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Mazyar Shadman](https://pubmed.ncbi.nlm.nih.gov/?term=Shadman+M&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Jenna Voutsinas](https://pubmed.ncbi.nlm.nih.gov/?term=Voutsinas+J&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA."), [Daniel S Hippe](https://pubmed.ncbi.nlm.nih.gov/?term=Hippe+DS&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA."), [Timothy W Randolph](https://pubmed.ncbi.nlm.nih.gov/?term=Randolph+TW&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA."), [Chaitra S Ujjani](https://pubmed.ncbi.nlm.nih.gov/?term=Ujjani+CS&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Christine Crider](https://pubmed.ncbi.nlm.nih.gov/?term=Crider+C&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA."), [Sara Keshmiri](https://pubmed.ncbi.nlm.nih.gov/?term=Keshmiri+S&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA."), [Stephen D Smith](https://pubmed.ncbi.nlm.nih.gov/?term=Smith+SD&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Ryan C Lynch](https://pubmed.ncbi.nlm.nih.gov/?term=Lynch+RC&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Mengyang Di](https://pubmed.ncbi.nlm.nih.gov/?term=Di+M&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Jennifer J Huang](https://pubmed.ncbi.nlm.nih.gov/?term=Huang+JJ&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Paul S Martin](https://pubmed.ncbi.nlm.nih.gov/?term=Martin+PS&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Brian G Till](https://pubmed.ncbi.nlm.nih.gov/?term=Till+BG&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA."), [Ajay K Gopal](https://pubmed.ncbi.nlm.nih.gov/?term=Gopal+AK&cauthor_id=42466974)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-1 "Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA.")[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42466974/#short-view-affiliation-2 "Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA.") ### Affiliations * 1 Clinican Research Division, Fred Hutchinson Cancer Center, Seattle, WA. * 2 Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA. * PMID: **42466974** * DOI: [ 10.1182/bloodadvances.2026020680 ](https://doi.org/10.1182/bloodadvances.2026020680) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract An increase in the absolute lymphocyte count (ALC) is a component of progressive disease (PD) in chronic lymphocytic leukemia (CLL) and contributes to progression-free survival in phase 3 trials. Prior studies with chemoimmunotherapy demonstrated that PD by ALC alone (ALC PD) conferred better outcomes than other modalities of PD (other PD). To evaluate the incidence and impact of ALC PD with modern treatments, we retrospectively examined 339 consecutive patients with CLL/small lymphocytic lymphoma treated between 2016 and 2025 at the University of Washington/Fred Hutchinson Cancer Center. Patients received frontline therapy with continuous Bruton tyrosine kinase inhibitors (BTKi; n = 179), bendamustine-rituximab (BR; n = 66), and time-limited B-cell lymphoma 2 inhibitors (BCL2i; n = 94). The cumulative incidence of ALC PD was higher with BR than BTKi and BCL2i (P = .021). Across treatment groups, overall survival (OS) from progression was longer for ALC PD than other PD (median, 116 vs 71 months; P = .0012; hazard ratio [HR], 3.15; 95% confidence interval [CI], 1.52-6.53), with 5-year OS rates of 83% and 56%, respectively. Time to next treatment o
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