Chronic Lymphocytic Leukemia

Question 1

What is chronic lymphocytic leukemia

Answer 1

Neoplastic proliferation of mature looking lymphoid cell

Question 2

Organs affected by chronic lymphocytic leukemia

Answer 2

Blood
bone marrow
lymphoid organs

Question 3

How do you differentiates Tronic lymphoid leukemia from acute lymphoblastic leukemia

Answer 3

Morphology of cell and degree of maturation

Lymphocytes are at different stages of development

Question 4

People affected by chronic lymphoid leukemia

Answer 4

Adults over 40 years old

Question 5

Classification of chronic lymphoid leukemia

Answer 5

B lymphoid leukemias

T lymphoid leukemia

Question 6

What are the b lymphoid leukemia

Answer 6

B-CLL
B -Prolymphocytic leukemia
Hairy cell leukemia
Plasma cell leukemia
Leukemic phase of indolent non-Hodgkin lymphoma

Question 7

T cell lymphoid leukemia

Answer 7

T- cll 
T- Prolymphocytic leukemia
Sezary syndrome
Adult T cell leukemia
Large granular lymphocytic leukemia
 Large cell lymphoma/ leukemia

Question 8

Which type of chronic lymphoid leukemia Half tendency to infiltrate the skin , are more aggressive and have a shorter course

Answer 8

T lymphoid leukemia

Question 9

T-CLL prognosis

Answer 9

Very bad , difficult to treat

Question 10

What do you see an histology of chronic lymphoid leukemia

Answer 10

Smear cell

Question 11

What is B -CLL

Answer 11

Progressive accumulation of immunologically incompetent lymphocytes

Question 12

Distribution of B-CLL in bone marrow

Answer 12

Interstitial, nodular , diffuse

Question 13

Progression of b-cll

Answer 13

Start in lymph node or bone marrow and expand to other hematopoietic organs

Question 14

Sex ratio B-CLL

Answer 14

M:F 2:1

Question 15

Percentage of b-cll in all leukemia

Answer 15

25% leukemias

Question 16

Main age affected by b cll and cll

Answer 16

45-70

40 for Ghanaians

Question 17

Markers found in lymphocytes of cll

Answer 17

CD23
CD25
CD27

Question 18

Genes involved in cll

Answer 18

Up regulation of anti apoptotic protein. - BCL2, MCL1, survivin

TNF alpha constantly expressed

Question 19

Complications of Cll

Answer 19

Involvement of all lymphoid organs
Massive splenomegaly 
Immune Paresis ,  recurrent infection
Auto immune hemolytic anemia 
Immune thrombocytopenic purpura 
Cytopeniaz

Question 20

Where is there anemias and thrombocytopenia in cll

Answer 20

Autoimmune phenomena
Marrow suppression of red cell and megakaryocyte
Hypersplenism

Question 21

Can CLL become large cell lymphoma

Answer 21

Yes , bad prognosis

Question 22

Clinical presentation of cll

Answer 22

Incidental discovery
Superficial lymph node enlargements
Anemia
Splenomegaly

Sometimes hemorrhage, aiha, mediastinal pressure, reduced gamma
Globulin, thrombocytopenia

Question 23

Diagnosis of cll

Answer 23

FBC , blood film - lymphocytosis
LFT, bue, cr 
Bone marrow trephine Immunohistochemistry and histology
Immunogentics 
Cytogenetic
Imaging

Question 24

Cll diagnostic criteria

Answer 24

Monoclonal lymphocyte count more than 5x10^9 /l
Cd5+ and cd23+ of cll
Cd19+ , cd209
Weak or negative FMC7 , CD79b

Question 25

Staging cll accepted

Answer 25

RAI

BINNET

Question 26

BINNET staging

Answer 26

A - 0-2 lymphoid organ areas
B - more than 2 areas , Hb >10g/dl, platelets >100x10^9

C- Hb <10g/dl , platelet < 100x10^9
C

Question 27

Treatment

Answer 27

Chlorambucil is the commonest drug used
Mostly 8mg for 7 days for the whole month
Combinations of CVP or CHOP are used for the more diffucult types of CLL(T-CLL)