Chronic Lymphocytic Leukaemia (CLL) Flashcards
Leukocyte relates to immune cells of the body. This can be divided into granulocytes (neutrophils, eosinophils, and basophils), monocytes, and lymphocytes (B, T and NK cells). Chronic lymphoblastic leukaemia (ALL) is a malignancy of precursor cells from the lymphocyte lineage. What is the incidence of ALL?
1 - 6 cases per 100,000
2 - 60 cases per 100,000
3 - 600 cases per 100,000
4 - 6000 cases per 100,000
1 - 6 cases per 100,000
Most common leukaemia in adults
Slightly more common in males 1.7:1 ratio
Leukocyte relates to immune cells of the body. This can be divided into granulocytes (neutrophils, eosinophils, and basophils), monocytes, and lymphocytes (B, T and NK cells). Acute lymphoblastic leukaemia (ALL) is a malignancy of precursor cells from the lymphocyte lineage. What age does the incidence of ALL typically peak?
1 - <12 months
2 - 1-5 years
3 - 10-20 years
4 - 60-70 years
4 - 60-70 years
When comparing leakaemia and lymphoma, which is a solid and which is a liquid tumour?
- leukaemia = liquid (blood)
- lymphoma = solid (lymph nodes)
When comparing leukaemia and lymphoma, which cells are generally affected?
- leukaemia = myeloid and lymphoid cells (all bone marrow cells)
- lymphoma = lymphoid cells (B, T and NK cells)
When looking at cell lines from the bone marrow we talk about haemopoietic stem cells, which are then able to differentiate into myeloid and lymphoid stem cells. Which of the following is NOT classed as a myeloid stem cell?
1 - erythrocyte
2 - thrombocyte (platelet)
3 - monocyte
4 - natural killer cell
5 - granulocyte
4 - natural killer cell
- these are classed as lymphoblasts
- granulocyte = eosinophil, neutrophil, basophil
When looking at cell lines from the bone marrow we talk about haemopoietic stem cells, which are then able to differentiate into myeloid and lymphoid stem cells. Which of the following is NOT classed as a lymphoblast stem cell?
1 - pre-B cell
2 - thrombocyte (platelet)
3 - Pre-T cell
4 - natural killer cell
2 - thrombocyte (platelet)
In chronic lymphoblastic leukaemia (CLL) do WBC mature normally, not at all or only partial maturation?
- partial maturation
Means cells don’t work properly, causing impaired
In chronic lymphoblastic leukaemia (CLL) WBCs only partially mature. Which of the following is a characteristic of CLL?
- cells divide too quickly
- cells do not die when they should
- cells do not die when they should
Results in an excess of immature WBCs
In chronic lymphoblastic leukaemia (CLL) WBCs only partially mature. Which of the following can this then affect the number of?
1 - RBCs
2 - platelets
3 - WBCs
4 - all of the above
4 - all of the above
Can cause:
- anaemia = low RBcs
- leukopenia - low WBCs
- thrombocytopenai = low platelets
- pancytopenia = low everything
Although not definitively known, which of the following has NOT be identified as a cause of chronic lymphoblastic leukaemia (CLL)?
1 - genetics
2 - environmental factors (smoking/radiation)
3 - viral exposure
4 - gender
4 - gender
HIV and AIDs patients 3x more likely to get CLL
One of the most common causes of chronic lymphoblastic leukaemia (CLL) is chromosomal abnormalities. Which of the following is NOT a type of chromosomal abnormalities that can lead to chronic leukaemia?
1 - chromosomal deletion
2 - trisomy
3 - isochromosome
4 - translocation
3 - isochromosome
In chronic lymphoblastic leukaemia (CLL) there is an interruption in normal B cell receptors, which is typically only switched on when there is an infection. Which 2 B cell receptors are linked with CLL?
1 - CD29
2 - CD23
3 - CD5
4 - CD4
2 - CD23
3 - CD5
In chronic lymphoblastic leukaemia (CLL) there is an interruption in normal B cell receptors, typically CD23 and CD5. Do these cells have high or low levels of surface immunoglobulins?
- low levels
This is why immune function is reduced.
In chronic lymphoblastic leukaemia (CLL), the oncogenic transformation of monoclonal B cells leads to the accumulation of lymphocytes in the bone marrow. These will then overflow and accumulate in lymphoid tissue. Where does CLL typically accumulate most though?
1 - spleen
2 - lymph nodes
3 - thymus
4 - mucous associated lymph tissue
2 - lymph nodes
Can collect anywhere, but specific preference for lymph nodes
Chronic lymphoblastic leukaemia (CLL) can transform in aggressive malignant. Which 2 of the following can CLL typically transform into?
1 - B-cell pro-lymphocytic leukaemia
2 - chronic myeloid leukaemia
3 - non-Hodgkin lymphoma
4 - horners malignancy
1 - B-cell pro-lymphocytic leukaemia
3 - non-Hodgkin lymphoma
Are patients with chronic lymphoblastic leukaemia (CLL) at an increased or decreased risk of developing:
- autoimmune hemolytic anaemias
- autoimmune thrombocytopenia.
- increased risk
Which of the following symptoms is present in 80% of patients with Chronic lymphoblastic leukaemia (CLL)?
1 - Frequent, severe night sweats
2 - Unexplained weight loss
3 - Lymphadenopathy
4 - High fever in the absence of any infections (>38°C)
3 - Lymphadenopathy
Commonly presents in the neck, armpits, groin
Which 2 of the following organs can become enlarged chronic lymphoblastic leukaemia (CLL)?
1 - lungs
2 - kidneys
3 - spleen
4 - liver
3 - spleen
4 - liver
In addition to lymphadenopathy and enlarged spleen and liver, which of the following can be a symptoms patients with chronic lymphoblastic leukaemia (CLL) present with?
1 - tiredness
2 - recurrent infections
3 - low neutrophil count
4 - bleeding and/or bruising
5 - all of the above
5 - all of the above
- tiredness = anaemia
- recurrent infections and low neutrophil count = low immunoglobulins
- bleeding and/or bruising = thrombocytopenia
Which of the following is NOT a B symptom in chronic lymphoblastic leukaemia (CLL)?
1 - Frequent, severe night sweats
2 - Unexplained weight loss
3 - Dysphagia
4 - High fever in the absence of any infections (>38°C)
3 - Dysphagia
If you suspect a diagnosis of chronic lymphoblastic leukaemia (CLL) a FBC should be performed. Which of the following is the clearest indicator of a diagnosis of CLL?
1 - neutropenia
2 - leukocytosis
3 - lymphocytosis
4 - thrombocytosis
3 - lymphocytosis
Typically >5000 B-lymphocytes/µL.
If a FBC is performed on a patient with suspected chronic lymphoblastic leukaemia (CLL) and revealed lymphocytosis )>5000 B-lymphocytes/µL), a blood smear is indicated to confirm the diagnosis. Which of the following is NOT a characteristics of the CLL on a blood smear?
1 - larger lymphocytes than healthy lymphocytes
2 - high amounts of cytoplasm
3 - round to irregular nuclei containing clumped chromatin
4 - all of the above
2 - high amounts of cytoplasm
There is typically a small amount of cytoplasm
When doing a blood smear if we suspected a diagnosis of chronic lymphoblastic leukaemia (CLL), which cell is a tell tale sign indicating CLL?
1 - smudge cells
2 - langerhans cells
3 - reed sternberg cells
4 - cytomegalovirus cells
1 - smudge cells
A characteristic morphologic feature is the presence of smudge cells which are artefacts from lymphocytes damaged during the slide preparation because of the fragile nature of these cells.
Which diagnostic test is confirmatory of chronic lymphoblastic leukaemia (CLL)?
1 - FBC
2 - blood smear
3 - HPLC
4 - immunophenotyping
4 - immunophenotyping
This test is especially important if the number of lymphocytes in the blood is only slightly elevated. It shows the characteristic clonal B lymphocytes expressing CD5 and CD23 antigens.
The british society of haematologists advocate for screening which gene in all patients diagnosed with chronic lymphoblastic leukaemia (CLL) prior to starting treatment?
1 - BRCA-1
2 - PARP-1
3 - TP53
4 - APC
3 - TP53
A deletion of the tumour suppressor gene TP53 is associated with adverse prognostic features predicting poorer treatment responses and survival in CLL.
Is a bone biopsy and aspirate always required to diagnose patients with chronic lymphoblastic leukaemia (CLL)?
- No
Helpful prior to therapy and to define complete response after treatment
In chronic lymphoblastic leukaemia (CLL), why would the direct antiglobulin test (coombs test) be performed?
1 - to assess for autoantibodies
2 - to identify blood type
3 - to assess if TP53 gene is present
4 - all of the above
1 - to assess for autoantibodies
It should be done in all anaemic patients and before commencing therapy to identify autoimmune-related haemolytic anaemias.
Which imaging is most commonly used to identify if there is obstruction or compression of structures due to chronic lymphoblastic leukaemia (CLL)?
1 - MRI
2 - ultraound
3 - CT
4 - X-ray
3 - CT
Is it possible to cure chronic lymphoblastic leukaemia (CLL)?
- No
But symptoms can be managed and CLL can be controlled
What staging system is used in the UK to stage patients with chronic lymphoblastic leukaemia (CLL)?
1 - epsowrth staging
2 - binet staging
3 - epstein staging
4 - TNM staging
2 - binet staging
1 lymph node area = one area where lymph nodes are present, even if its bilateral
In the early stages of chronic lymphoblastic leukaemia (CLL), which of the following should be implemented?
1 - watch and wait
2 - chemotherapy
3 - radiotherapy
4 - surgery
1 - watch and wait
Close monitoring of blood cell counts and clinical examinations to determine whether the disease is stable or beginning to progress
Should all patients with chronic lymphoblastic leukaemia (CLL) be given chemotherapy?
- no
Only those with active and symptomatic disease
Which of the following is NOT an indication for beginning chemotherapy in a patient with chronic lymphoblastic leukaemia (CLL)?
1 - progressive marrow failure
2 - massive/symptomatic splenomegaly
3 - massive/symptomatic lymphadenopathy
4 - Pancytopneia
5 - Progressive lymphocytosis
4 - Pancytopneia
Which of the following symptoms is NOT an indication to begin chemotherapy in a patient with chronic lymphoblastic leukaemia (CLL)?
1 - Night sweats
2 - High fever
3 - Extreme fatigue
4 - Unintentional weight loss >10%
5 - Bone pain
5 - Bone pain
Patients with chronic lymphoblastic leukaemia (CLL) are at an increased risk of autoimmune cytopneia (low RBCs, WBCs and/or platelets). Cytopneia is a common complication of CLL. What is the treatment of choice in these patients?
1 - corticosteroids
2 - methotrexate
3 - bendamustine
4 - alemtuzumab
1 - corticosteroids
Also useful for improving bone marrow function
Which of the following correctly defines relapsed in chronic lymphoblastic leukaemia (CLL)?
1 - normal lymphoblast levels in blood
2 - CLL responds to therapy but >6 CLL stopped responding
3 - CLL may be stable or worse <6 months of the last treatment.
4 - CLL free for >12 months
2 - CLL responds to therapy but >6 CLL stopped responding
Which of the following correctly defines refractory in chronic lymphoblastic leukaemia (CLL)?
1 - normal lymphoblast levels in blood
2 - CLL responds to therapy but >6 CLL stopped responding
3 - CLL may be stable or worse <6 months of the last treatment.
4 - CLL free for >12 months
3 - CLL may be stable or worse <6 months of the last treatment.
Which of the following treatments provides the best opportunity of achieving long‐term disease‐free survival for patients with high‐risk chronic lymphoblastic leukaemia (CLL), including those with TP53 abnormalities?
1 -corticosteroids
2 - allogeneic stem‐cell transplantation
3 - bendamustine
4 - alemtuzumab
2 - allogeneic stem‐cell transplantation
Patients receives blood products from a healthy donor
Are patients with chronic lymphoblastic leukaemia (CLL) at an increased or decreased risk of developing other secondary malignancies?
- increased risk
Hyperviscosity syndrome can occur in patients with chronic lymphoblastic leukaemia (CLL). What causes this?
1 - extremely high RBC number
2 - extremely high WBC number
3 - extremely high platelet number
4 - any of the above
2 - extremely high WBC number
Can cause:
- headaches
- dizziness
- vertigo
- hearing loss
- visual disturbances and nystagmus.
