103 - Chronic Lymphocytic Leukemia

Question 1

CLL (chronic lymphocytic leukemia) is a ____ of adult lymphocytes. >___

Answer 1

monoclonal proliferation

5X10^9 malignant cells/mL blood

Question 2

The presence of ___ <5X10^9
without ___, ___, or ____ involvement and absent cytopenia is a precursor of CLL called ___ (MBL) with 1–2% chance per year of progressing to overt CLL

Answer 2

malignant B cells
nodal
spleen
liver
monoclonal B-cell lymphocytosis

Question 3

CLL is more common in adults with the median age of __. more common in __, but as age progresses sex ratio equalize.

Answer 3

71

men

Question 4

First degree family member with CLL increases the chance of CLL in ___times.

Answer 4

8.5

Question 5

The common aberrations in CLL are: (3)

Answer 5

del(13)(q14.3)
del(11)(q22.3)
del(17)(p13.1)

Question 6

del(13)(q14.3) usually a ___ mutation. It is more ___, has ___ prognosis and ___ to medical treatment.

Answer 6

Stand alone
indolent
better
responsiveness

Question 7

del(11)(q22.3) is connected to ___ gene deletion. It is in association with ___ and a more ___ disease. It is more common in ___patients and has worse prognosis, becoming symptomatic more quickly with bad responsiveness to treatment

Answer 7

ATM
lymphadenopathy
aggressive
young

Question 8

del(17)(p13.1) has the ___ prognosis. it is connected to the deletion of ___ gene which is a TSG.

Answer 8

worse

TP53

Question 9

In CLL normal __ cell count decreaseד. In ___% of CLL patients present with hypogammaglobulinemia

Answer 9

B

85%

Question 10

The presentation of CLL most commonly occurs as an ___ diagnosis. CLL is most commonly diagnosed on routine blood work demonstrating an elevated ____ count in ____ individuals.

Answer 10

incidental
lymphocyte
asymptomatic

Question 11

When performing flow cytometry it is possible to see typical markers such as: ___, ___, ___

Answer 11

CD20
CD22
CD23

Question 12

What is the most common cause for mortality and morbidity in CLL?

Answer 12

Infections

Question 13

Prophylaxis for __ and ___ are recommended when treating CLL.

Answer 13

PCP

VZV

Question 14

___ vaccines should be avoided in CLL patients.

Answer 14

Live

Question 15

___ has not been proven to improve ___ but it does decrease ___ infections occurrence

Answer 15

IVIG
Survival
bacterial

Question 16

Indications for IVIG in CLL patients include: (4)

Answer 16

1. Hypogammaglobulinemia + recurrent infections/pulmonary bronchiectasis
2. Hypogammaglobulinemia + influenza
3. Hospitalization due to severe infection
4. IgG<300 mg/dL

Question 17

CLL patients are X8-15 more in risk to develop sever ___ malignancies. Other in risk malignancies include: (2)

Answer 17

skin
breast
prostate

Question 18

CLL patients are in higher risk for different autoimmune complications, name 5 of them:

Answer 18

1. Cytopenia
2. Glomerulonephritis
3. Vasculitis
4. AIHA- the most common
5. ITP- second most common

Question 19

In AIHA lab results we can find: high percentage of ___, elevated ___ and ___, low ___

Answer 19

reticulocytes
bilirubin
LDH
haptoglobin

Question 20

CLL patients with AIHA should be treated with:

Answer 20

Blood units

Immunosuppression (GC->steroids/rituximab)

Question 21

How do you call combine ITP and AIHA?

Answer 21

Evan’s syndrome

Question 22

What will you see in Evan’s syndrome?

Answer 22

Isolated thrombocytopenia

Question 23

What is Richter’s transformation?

Answer 23

CLL transformation to a more aggressive type such as DLBCL (Diffuse large B-cell lymphoma) or HL

Question 24

In Richter’s syndrome we will see fast developing ___ usually located and with ___ symptoms. ___ levels tend to be high/

Answer 24

Lymphadenopathy
B
LDH

Question 25

In order to diagnose ___ the preferred method is ___and is better than ___. Treatment includes a combination of chemotherapeutic agents, and survival is between ___ months

Answer 25

Richter’s syndrome
excisional biopsy
needle biopsy
6-16

Question 26

Most CLL patients do not require treatment when diagnosed but inly when ___

Answer 26

symptomatic

Question 27

Patients under 65 should be treated with FCR ( ___,___,___)

Answer 27

Fludarabine
Cyclophosphamide
Rituximab

Question 28

In patients >65 treatment includes: ___ + ___ or ___

Answer 28

Chlorambucil
Rituximab
Obinutuzumab

Question 29

Ibrutinib is a selective irreversible inhibitor for __ cells. It was found to be more efficient than chlorambucil.

Answer 29

B

Question 30

The only curative treatment for CLL is ____, but it holds much ___ and risk

Answer 30

Stem cells transplantation

comorbidity

Question 31

After treatment, we should assess responsiveness by ___ and ___. Cured patients are considered to have

Answer 31

biopsy
flow cytometry
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