According to research performed at North Shore Long Island Jewish Medical Center in Manhasset, NY, pulmonary complications related to chronic lymphocytic leukemia (CLL) are common and changing secondary to both chemotherapeutic / biologic treatments and the emergence of resistant organisms. They described their research at CHEST 2011, the 77th annual meeting of the American College of Chest Physicians, in Honolulu. Ali Chaudhry, MD, and colleagues performed a retrospective chart review was performed on 75 consecutive inpatients at a CLL referral center. All patients had a diagnosis code of CLL and pulmonary disease. The data were analyzed for the frequency of specific pulmonary manifestations. The risk factors for mortality were analyzed using the Fisher’s exact test and Mann-Whitney test. The mean age of patients at admission was 74.8 years; 86% had a high RAI score. Sixty-one percent were male. Fludarabine, cyclophosphamide, and rituxan was the most common treatment regimen. Dr. Chaudhry and colleagues found that cough and dyspnea (74%) were frequent admission complaints. Pneumonia was the most prevalent diagnosis on admission (66%). Pseudomonas, followed by Pneumocystis, were the typical organism identified (35%, 18%, respectively) in those with pneumonia, compared with the previous decade when it was Staphylococcus aureus. In the previous study, PCP was then seen only in two of 110 patients. The most common non-infectious complication was pleural effusion, seen in 22 patients (30%). In 13 (60%) of patients, the effusion was consistent with a hydrostatic cause. In nine (40%) of patients the effusion was directly related to CLL. Further, a high BUN, RAI score, and a low ANC independently predicted mortality. The investigators concluded that newer regimens to treat CLL, including biological therapies, coupled with intrinsic immune dysregulation, predispose the patients to numerous infections. The recognition of independent variables for mortality and causative organisms may help in management of these patients by allowing the appropriate prophylactic, diagnostic, and therapeutic measures, they stated.