Chronic Leukemias Flashcards
Chronic Lymphocytic Leukemia introduction
B cell > T cell
>50 yrs. median 70 yrs.
higher incidence in males
high survival rate
CLL Pathogenesis
lymphocytes are not able to fight infection well
increase in abnormal lymphs
CLL Symptoms
may be asymptomatic
commonly discovered accidentally
CLL Lab findings
WBC - 30-200x10^9
abundant pale-staining
smudge cells & high % of lymphs (mostly mature)
CD19+, CD5+, CD20+
Chronic Myelogenous Leukemia
AKA chronic granulocytic leukemia
older patients
affects myeloid cells in BM
CML pathophysiology
overproduction of defective granulocytes
acquired chromosomal abnormality - philadelphia chromosome (Ph)
3 phases: chronic, accelerated, blast crisis
Philadelphia Chromosome
not everyone w/ CML will have it (95%) & not everyone who has it will have CML (maybe AML)
t(9;22) - abnormally short chromosome 22
encodes abnormal protein w/ enhanced tyrosine kinase activity which suppresses apoptosis in hematopoietic cells
CML symptoms
can be asymptomatic fever/ night sweats weight loss weakness splenomegaly bruising
CML classification
Ph+ 90-95% of cases
Ph - 5-10% of cases (now reclassified as MPD/MDS disorder)
Chronic phase of CML
progresses slowly 2-5 years
responses to treatment
patients are diagnosed during this phase
Accelerated phase of CML
3-5 yrs after diagnosis
fewer mature cells, begin to see immature cells
resistant to therapy
symptoms worsen
Blastic crisis phase of CML
3/4 of patients enter
unresponsive to therapy
resembles acute leukemia w/ many blasts
survival usually less than 6 months
CML chronic phase lab findings in PB
extreme leukocytosis
increase in mature granulocytes
left shift
normo, normo anemia
CML chronic phase lab findings in BM
hypercellular
striking increase in M:E ratio - 10:1 to 50:1
granulocytes in all stages of development
CML treatment
Gleevac!! or imatinib mesylate
