Chronic Lymphocytic Leukaemia Flashcards
What is Chronic Lymphocytic Leukaemia?
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
In which people is it most commonly seen in?
- Older people above 55 years old
What are the different types of Chronic Leukaemia?
- Prolymphocytic leukaemia
- Hairy cell leukaemia
- Richter’s Syndrome
What is Prolymphocytic leukaemia?
- CLL can change into Prolymphocytic leukaemia
What is Richter’s Syndrome?
- When CLL develops into a high grade Lymphoma
What is Hairy Cell Leukaemia?
- 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
What are the symptoms of CLL?
- Swollen lymph glands ( axillary lymph nodes or an enlarged spleen)
- Weight loss
- Constant infections
- Anaemia/ Feeling tired
- Bleeding/ Bruising
- Bone pain/ Night Sweats
What are the tests you would do for CLL?
- FBC
- U+E
- LFTs
- Immunophenotyping
- FISH gene changes
- Certain antibodies ( DAT - Direct Anti-globulin test)
- Serum immunoglobulins
- Lactate dehydrogenase
- BLOOD FILM = Smear/ Smudge cells
What FISH gene changes are there?
- TP53
- IGHV
How is CLL staged?
- There are two staging systems:
- Binet Staging System
- Rai Staging
What is the Binet Staging System?
- 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
What is the Rai Staging System?
- 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
What are the stages of treatment for prostate cancer?
- Watch and wait
- First line treatment
- treatment when CLL comes back
What is involved in watch and wait?
- 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
What is the first line treatment for CLL dependant on?
- A TP53 mutation
What is the treatment for TP53 gene negative mutation?
- a targeted drug such as acalabrutinib
-venetoclax and obinutuzumab - Chemotherapy
What is the treatment for TP53 gene positive mutation?
- a targeted drug such as acalabrutinib
-venetoclax and obinutuzumab
NO CHEMOTHERAPY
What are the Risk Factors of Developing CLL?
- Age (older - above 40)
- Sex ( male)
- Family History
- Exposure to Chemicals
What are other treatments for CLL?
- 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
When would you have Radiotherapy?
- Enlarged Spleen
- Bulky lymph nodes
- Bone Pain
What is the follow up for CLL?
- Blood tests
- Bone Marrow tests
Why is the reticulocyte count high in CLL?
- warm autoimmune haemolytic anaemia
What are the complications of CLL?
- anaemia
- hypogammaglobulinaemia - infections
- Warm Autoimmune haemolytic anaemia
- Richter’s transformation
