Chronic Lymphocytic Leukaemia

Question 1

What is Chronic Lymphocytic Leukaemia?

Answer 1

It is a type of cancer that affects WBC in the blood and the bone marrow
- proliferation of well-differentiated lymphocytes - almost always B cells
- they are morphologically mature but functional incompetent

Question 2

In which people is it most commonly seen in?

Answer 2

• Older people above 55 years old

Question 3

What are the different types of Chronic Leukaemia?

Answer 3

• Prolymphocytic leukaemia
• Hairy cell leukaemia
• Richter’s Syndrome

Question 4

What is Prolymphocytic leukaemia?

Answer 4

• CLL can change into Prolymphocytic leukaemia

Question 5

What is Richter’s Syndrome?

Answer 5

• When CLL develops into a high grade Lymphoma

Question 6

What is Hairy Cell Leukaemia?

Answer 6

• This is a type of chronic leukaemia that is rarer than CLL or CML
• The leukaemia cells have outgrowths that look like tiny hairs on the surface

Question 7

What are the symptoms of CLL?

Answer 7

• Swollen lymph glands ( axillary lymph nodes or an enlarged spleen)
• Weight loss
• Constant infections
• Anaemia/ Feeling tired
• Bleeding/ Bruising
• Bone pain/ Night Sweats

Question 8

What are the tests you would do for CLL?

Answer 8

• FBC
• U+E
• LFTs
• Immunophenotyping
• FISH gene changes
• Certain antibodies ( DAT - Direct Anti-globulin test)
• Serum immunoglobulins
• Lactate dehydrogenase
• BLOOD FILM = Smear/ Smudge cells

Question 9

What FISH gene changes are there?

Answer 9

• TP53
• IGHV

Question 10

How is CLL staged?

Answer 10

• There are two staging systems:
• Binet Staging System
• Rai Staging

Question 11

What is the Binet Staging System?

Answer 11

• Stage A - there is less than 3 groups of swollen lymph nodes
• Stage B - there is 3 or more groups of enlarged lymph nodes
• Stage C - you have a low number of red blood cells and platelets

Question 12

What is the Rai Staging System?

Answer 12

• Stage 0 = you have a high number of lymphocytes
• Stage 1 = you have a high number of lymphocytes and enlarged lymph nodes
• Stage 2 = above and enlarged liver/ spleen
• Stage 3 = above and low RBC
• Stage 4 = above and low number of platelets

Question 13

What are the stages of treatment for prostate cancer?

Answer 13

• Watch and wait
• First line treatment
• treatment when CLL comes back

Question 14

What is involved in watch and wait?

Answer 14

• This is where your doctor might decide not to give any treatment and instead keep an eye on the blood results
• This is because you have no bothering symptoms/ your CLL is slow growing

Question 15

What is the first line treatment for CLL dependant on?

Answer 15

• A TP53 mutation

Question 16

What is the treatment for TP53 gene negative mutation?

Answer 16

• a targeted drug such as acalabrutinib
  -venetoclax and obinutuzumab
• Chemotherapy

Question 17

What is the treatment for TP53 gene positive mutation?

Answer 17

• a targeted drug such as acalabrutinib
  -venetoclax and obinutuzumab

NO CHEMOTHERAPY

Question 18

What are the Risk Factors of Developing CLL?

Answer 18

• Age (older - above 40)
• Sex ( male)
• Family History
• Exposure to Chemicals

Question 19

What are other treatments for CLL?

Answer 19

• Radiotherapy (de-bulking - local lymphadenopathy)
• Surgery (Splenectomy)
• Stem cell transplant
• chemotherapy = Fludarabine + Cylcophosphamide + Rituximab
• autoimmune cytopaenia - warm autoimmune haemolytic anaemia - bone marrow failure = give steroids

Question 20

When would you have Radiotherapy?

Answer 20

• Enlarged Spleen
• Bulky lymph nodes
• Bone Pain

Question 21

What is the follow up for CLL?

Answer 21

• Blood tests
• Bone Marrow tests

Question 22

Why is the reticulocyte count high in CLL?

Answer 22

• warm autoimmune haemolytic anaemia

Question 23

What are the complications of CLL?

Answer 23

• anaemia
• hypogammaglobulinaemia - infections
• Warm Autoimmune haemolytic anaemia
• Richter’s transformation