Chronic Leukocytic Leukemia - Nikcevich Flashcards
Chronic Lymphocytic Leukemia:
Most common leukemia in adults
Median age = 65 y/o
Median survival = 9 yrs
Only curative therapy of CLL?
Allogeneic stem cell transplant
CLL pathophysiology:
- uncontrolled clonal accumulation of mature lymphocytes
- Mutated Ig variant heavy genes ==better prognosis
Nonmutated ==worse prognosis
TEST Q: How do you diagnose CCL?
FLOW CYTOMETRY:
CD5+ CD19+ CD20+ CD23+
What’s the difference between CLL and SLL (small lymphocytic lymphoma)?
SLL is the tissue phase of CLL – there is no leukemia in the peripheral blood, it is in the lymph nodes
Mantle Cell lymphoma
Markers to look for?
-Nasty, aggressive NHL
CD5 +
CD23 –
cyclinD1 +
Clinical features of CLL
- often incidental diagnosis
- Progressive adenopathy
- Fatigue, malaise, weight loss, fevers
Autoimmune complications of CLL?
- AIHA –lots of reticulocytes (DAT/Coombs)
- Pure red cell aplasia – No reticulocytes
- can be caused by parvovirus - Idiopathic thrombocytopenic purpura (ITP)
- Neutropenia
Classifications for staging?
Rai system –use to assign survival
Binet System
What kind of study should you ALWAYS get with CLL?
FISH
CLL cytogenetic abnormalities (best to worst)
13q- BEST Normal karyotype Trisomy 12 11q- 17p- WORST
CD38 is used as surrogate marker for IG gene mutations
What do we find?
use flow cytometry
CD38+ =unmutated Ig genes ==poorer prognosis (9 yr median survival)
CD38– = mutated Ig genes == better prog (>20yr median survival)
ZAP-70+ means what for prognosis?
Poorer prognosis :(
Correlates with CD38+ expression
Correlates with Ig Vh gene mutation
When to treat CLL?
Usually only if symptoms are constitutional and/or if they are progression
Secondary prolymphocytic leukemia:
- Get it from treating primary leukemia
- Richter’s transformation
- New 17p-
- Poor prognostic sign
