Chronic Lymphocytic Leukaemia (CLL) Flashcards
How is CLL diagnosed?
routine full blood count showing a raised white cell count
How many CLL newly diagnosed CLL patients are asymptomatic?
25% - 50%
What kind of symptoms do patients with more advanced CLL show?
- enlarged lymph nodes
- anaemia resulting from low red blood cell
- bruising resulting from
low platelet count
What can be seen when looking at blood film from CLL patients?
- smudge cells
- these are damaged lymphocytes caused by cytoskeletal defects
How is a definitive diagnosis of CLL made?
- using lab technique called flow cytometry
- clonal expansion of light chain-restricted B cells and co-expression of CD5 and CD19 antigens are signs
Which protein markers are often used in the flow cytometric analysis?
- CD43 +
- CD79b (weak)
- CD81 (weak)
- CD200 +
- CD10 -
- ROR1 +
What is the most common prognostic tool?
clinical staging
What clinical staging system do we use in europe?
Binet Staging System
What are the stages in the binet staging system?
- Stage A
- Stage B
- Stage C
What is Stage A of the binet staging system?
- confirmed diagnosis of CLL
- CD5+/CD19+ lymphocytosis of over 5x10^9 per litre
What is Stage B of the binet staging system?
- same as stage A but with at least 3 areas of palpable lymphoid tissue enlargement
What is Stage C of the binet staging system?
- haemoglobin under 100g/L
OR - platelet count under 100/microlitre
- these both signify a degree of bone marrow failure
What are the most important independent prognostic markers for Stage A patients?
- lymphocyte doubling time (LDT)
- immunoglobin heavy chain gene mutation (IGHV)
- CD38 and CD49d, high cell surface expression for either or both
- p53 mutation or deletion
What are some fixed duration treatment options?
- venetoclax + obinutuzumab
- ibrutinic + venetoclax
What are some continuous treatment options?
- acalabrutinib
- zanubrutinib
- ibrutinib
