Chronic Leukemias Flashcards
Which is more common, CML or CLL?
CLL is MUCH more common
What gene do 90% of CML patients have?
bcr-abl (philadelphia chromosome) in 90% of CML patients
What are the 3 phases of CML?
Chronic phase
Accelerated phase
Blast Crisis
What are characteristics of the chronic phase in CML?
<10% blasts in periphery
Asymptomatic
What are characteristics of the accelerated phase of CML?
10-19% blasts in periphery
impaired neutrophil differentiation
Splenomegaly from extramedullary hematopoiesis
What is blast crisis in CML?
> 20% blasts in periphery
Differentiate from AML by midstage progenitor cells
What is the prognosis of CML?
3 years w/o treatment
Good if complete cytogenetic response on Imatinib by 18 months (undetectable philadelphia chromosome in bone marrow)
How is CML treated?
Imatinib
tyrosine kinase inhibitor, blocks function of Bcr-Abl, inhibits proliferation, induces apoptosis
Interferon-alpha
How to chronic leukemias present?
Typically asymptomatic
How does CML present?
Leukocytosis, thrombocytosis, basophilia, extended left shift
Splenomegaly
How does CLL present?
Lymphocytosis of B lymphocytes
Lymphadenopathy
Splenomegaly (later)
Cytopenias
When is CML treatment started?
Imatinib started at time of diagnosis
When is CLL treatment started?
May never need treatment
What is the prognosis for CLL
Mean survival is 10-25 years
Incurable, but slow progression
How is CLL treated?
Chemotherapy has diminishing returns
Rituximab
