Chronic Lymphocytic Leukaemia

Question 1

What is seen on blood film in CLL?

Answer 1

smudge cells

Question 2

What is the immunophenotypic profile of CLL?

Answer 2

aberrant co expression of CD5, CD19 and CD23

Question 3

What differentiates CLL from a leukaemic manifestation of mantle cell lymphoma?

Answer 3

CD23

Question 4

What is the most common reason for diagnosis of CLL?

Answer 4

incidental finding on an FBE (60% of patients asymptomatic at diagnosis)

Question 5

How is CLL staged?

Answer 5

Binet A = Hb > 100, plt > 100 and < 3 LN regions
Binet B = Hb > 100, plt > 100
Binet C = Hb < 100, plt < 100

Question 6

What are the poor prognostic markers of CLL?

Answer 6

elevated beta 2 microglobulin
elevated LDH
certain molecular/chromosomal markers on FISH e.g. 17p deletion

Question 7

What are the autoimmune complications of CLL?

Answer 7

autoimmune haemolytic anaemia

immune thrombocytopaniea purpura

Question 8

What are the indications for commencing treatment in CLL?

Answer 8

worsening anemia/thrombocytopaenia
massive/symptomatic splenomegaly
massive lymphadenopathy
singificantly progressive lymphocytosis
AIHA or ITP unresponsive to steroids
symptomatic extranodal involvement
constitutional symptoms

Question 9

What is the standard treatment for CLL?

Answer 9

rituximab, fludarabine and cyclophosphamide

Question 10

Which patients should you use ibrutinib for in CLL?

Answer 10

17p deletion or p53 mutation

Question 11

What is the mechanism of action of ibrutinib?

Answer 11

BTK inhibitor

Question 12

What are the side effects of ibrutinib?

Answer 12

bruising, diarrhoea, fatigue, AF

Question 13

What is the mechanism of action of venetoclax?

Answer 13

Bcl-2 inhibitor

Question 14

Which patients get venetoclax in CLL?

Answer 14

relapsed or refractory CLL with 17p deletion