Chronic Leukemia

Question 1

define CLL

Answer 1

proliferation of mature but nonfunctional lymphoid cells – most commonly B cells

Question 2

define CML

Answer 2

proliferation of mature but nonfunctional myeloid cells like neutrophils, basophils, and eosinophils

Question 3

tell me about the epi of CLL and CML

Answer 3

CLL – mostly in elderly individuals; many die with it rather than from it

CML – more in the middle aged population

Question 4

CLL can undergo ____ transformation into _____ lymphoma

Answer 4

Richter’s
small lymphocytic lymphoma

Question 5

does CLL or CML characteristically have the t(9;22) BCR:ACL oncoprotein, philadelphia chromosome?

Answer 5

CML

Question 6

tell me about the phases of CML

Answer 6

1. chronic phase - pts can be asymptomatic and might not progress out of this stage if its well controlled
2. acute phase - pts start developing blasts and start experiencing more of the classic leukemia s/s
3. blast crisis - pt has >20% blasts and starts experiencing the s/s of AML

Question 7

what s/s might be more characteristic in CLL vs CML?

Answer 7

CLL
- leukemia cutis + other derm findings
- hemolytic anemia or other autoimmune developments
- increased LAD
- increased risk of infection
CML
- typical s/s of leukemia, increases in severity with progression into blast crisis

Question 8

how do you dx CML and CLL

Answer 8

CLL – PBS ➔ smear cells “crushed little lymphocytes”
- doesnt usually need a bone marrow
- can do flow cytometry/immunophenotyping to determine type of CLL

CML
- PBS ➔ increased mature myeloid cells
- genetic testing to identify Ph chromosome - karyotyping or FISH
- BM biopsy

Question 9

how do you tx CLL

Answer 9

can do watching waiting or active surveillance if the pt is older etc.

not curable disease; give tx to help manage s/s:
- Antimetabolite
- Alkylating agents
- Immunotherapy (anti-CD20; rituximab)

can consider allogenic stem cell transplant

Question 10

how do you tx CML

Answer 10

1. tyrosine kinase inhibitor vs the Philadelphia chromosome
2. hydroxyurea - palliative bc myelosuppressive

can consider allogenic stem cell transplant

Question 11

what cx are we concerned about with CLL

Answer 11

leukocytosis ➔ leukostasis

increased amount of leukocytes = thicker more viscous blood ➔ lead to s/s of hypoperfusion and VTE