103 - Chronic Lymphocytic Leukemia Flashcards
CLL (chronic lymphocytic leukemia) is a ____ of adult lymphocytes. >___
monoclonal proliferation
5X10^9 malignant cells/mL blood
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
malignant B cells nodal spleen liver monoclonal B-cell lymphocytosis
CLL is more common in adults with the median age of __. more common in __, but as age progresses sex ratio equalize.
71
men
First degree family member with CLL increases the chance of CLL in ___times.
8.5
The common aberrations in CLL are: (3)
del(13)(q14.3)
del(11)(q22.3)
del(17)(p13.1)
del(13)(q14.3) usually a ___ mutation. It is more ___, has ___ prognosis and ___ to medical treatment.
Stand alone
indolent
better
responsiveness
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
ATM
lymphadenopathy
aggressive
young
del(17)(p13.1) has the ___ prognosis. it is connected to the deletion of ___ gene which is a TSG.
worse
TP53
In CLL normal __ cell count decreaseד. In ___% of CLL patients present with hypogammaglobulinemia
B
85%
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.
incidental
lymphocyte
asymptomatic
When performing flow cytometry it is possible to see typical markers such as: ___, ___, ___
CD20
CD22
CD23
What is the most common cause for mortality and morbidity in CLL?
Infections
Prophylaxis for __ and ___ are recommended when treating CLL.
PCP
VZV
___ vaccines should be avoided in CLL patients.
Live
___ has not been proven to improve ___ but it does decrease ___ infections occurrence
IVIG
Survival
bacterial
Indications for IVIG in CLL patients include: (4)
- Hypogammaglobulinemia + recurrent infections/pulmonary bronchiectasis
- Hypogammaglobulinemia + influenza
- Hospitalization due to severe infection
- IgG<300 mg/dL
CLL patients are X8-15 more in risk to develop sever ___ malignancies. Other in risk malignancies include: (2)
skin
breast
prostate
CLL patients are in higher risk for different autoimmune complications, name 5 of them:
- Cytopenia
- Glomerulonephritis
- Vasculitis
- AIHA- the most common
- ITP- second most common
In AIHA lab results we can find: high percentage of ___, elevated ___ and ___, low ___
reticulocytes
bilirubin
LDH
haptoglobin
CLL patients with AIHA should be treated with:
Blood units
Immunosuppression (GC->steroids/rituximab)
How do you call combine ITP and AIHA?
Evan’s syndrome
What will you see in Evan’s syndrome?
Isolated thrombocytopenia
What is Richter’s transformation?
CLL transformation to a more aggressive type such as DLBCL (Diffuse large B-cell lymphoma) or HL
In Richter’s syndrome we will see fast developing ___ usually located and with ___ symptoms. ___ levels tend to be high/
Lymphadenopathy
B
LDH
In order to diagnose ___ the preferred method is ___and is better than ___. Treatment includes a combination of chemotherapeutic agents, and survival is between ___ months
Richter’s syndrome
excisional biopsy
needle biopsy
6-16
Most CLL patients do not require treatment when diagnosed but inly when ___
symptomatic
Patients under 65 should be treated with FCR ( ___,___,___)
Fludarabine
Cyclophosphamide
Rituximab
In patients >65 treatment includes: ___ + ___ or ___
Chlorambucil
Rituximab
Obinutuzumab
Ibrutinib is a selective irreversible inhibitor for __ cells. It was found to be more efficient than chlorambucil.
B
The only curative treatment for CLL is ____, but it holds much ___ and risk
Stem cells transplantation
comorbidity
After treatment, we should assess responsiveness by ___ and ___. Cured patients are considered to have
biopsy
flow cytometry
0.01%
