Chronic Leukemia

Question 1

Discuss this image for arielle
Only CLL is covered in the book

Question 2

What is the most common leukaemia in adults?
Is it more common in males or females?

Answer 2

CLL M>F (just like acute leukaemia)

Question 3

What is CLL?
And tell me how it differs from ALL

Answer 3

CLL is the progressive accumulation of mature but dysregulated lymphocytes.

They both involve dysregulated lymphocytes. ALL is the uncontrolled proliferation of immature stem cells whereas CLL is the abnormal survival (lack apoptosis) of mature cells => slow progression

Question 4

Are lymphocytes in CLL monoclonal?

Answer 4

Yes they are monoclonal

Question 5

Is pancytopenia a clinical feature of CLL as it is in ALL and AML?

Answer 5

Not really, only in very severe cases

Question 6

What is haemoglobin expected to be in CLL?

Answer 6

Normal >10

Question 7

Unlike ALL, CLL is often asymptomatic and found incidentally. How is it found incidentally?

What are the clinical features (sx&sx) found in the disease

Answer 7

FBC showing lymphocytic leukocytosis (e.g. lots of B cells)

Question 8

RF of CLL?

Answer 8

Question 9

What is the grading scale used in CLL called?
what investigations are needed for this?

Answer 9

Binet Clinical staging
FBC - haemoglobin and platelet count
CTTAP - organ involvement

Question 10

What is Binet grading scale?
Go through it

Answer 10

Grading scale used to clinically stage CLL
Note: <10 for Stage C
Also Note
A = Early stage
B = Localised CLL
C - Advanced CLL

Question 11

What are expected findings of an FBC in CLL?

Answer 11

lymphocytic leukocytosis
+/- Anaemia and thrombocytopenia in Stage C

Question 12

What is the expected finding on a bloodsmear of CLL?

Answer 12

Smear cells

Question 13

What is the main diagnostic
Blood:
Procedure:
for CLL, including expected findings

Answer 13

Blood: Immunophenotyping by flow cytometry showing CD20+ with light chain restriction and Co-expression of CD5 + CD 23

Procedure: BM aspirate/biopsy - Lymphocytosis

Question 14

There is a severe and aggressive version of CLL, what is it called?
What additional investigation is required for the diagnosis of this version?
What findings on the U&E would also be found in this version but not in regular CLL?

Answer 14

Richter transformation

LN biopsy: For dx of Richter transformation, SLL (small lymphocytic lymphoma.- another type), and to further confirm the dx of CLL if uncertain

U&E: High LDG + Serum calcium

Question 15

For all leukemia what type of immunophenotyping is used?

Is that from the blood or BM or what?

Answer 15

Flow cytometry

Acute Leukemias - BM
Chronic leukemias - Blood

Question 16

Go through the necessary investigations for CLL

Answer 16

Question 17

What’re the indications for immediate treatment in CLL?

Answer 17

Stage C (Hb <10, platelets <100) or Lymphadenopathy >10 cm

Question 18

Just for your information,
A = Early stage
B = Localised CLL
C - Advanced CLL

State the management of each
+ the management in relapse

Answer 18

Question 19

The prognosis of CLL is very variable ranging from 2 to 20 years so…. Whatre the 3 top complications of CLL + complications of treatment

Answer 19

Complications of treatment:
Febrile neutropenia
Tumour lysis syndrome
Alopecia
Cardiotoxicity
Infertility
Risk for secondary malignancy
Endocrinopathies (impaired glucose and insulin metabolism, thyroid dysfunction)
Remember, steroids were really only given in ALL so adrenal insufficiency not relevant here