Chronic Lymphocytic Leukemia Flashcards
What is chronic lymphocytic leukemia
Neoplastic proliferation of mature looking lymphoid cell
Organs affected by chronic lymphocytic leukemia
Blood
bone marrow
lymphoid organs
How do you differentiates Tronic lymphoid leukemia from acute lymphoblastic leukemia
Morphology of cell and degree of maturation
Lymphocytes are at different stages of development
People affected by chronic lymphoid leukemia
Adults over 40 years old
Classification of chronic lymphoid leukemia
B lymphoid leukemias
T lymphoid leukemia
What are the b lymphoid leukemia
B-CLL B -Prolymphocytic leukemia Hairy cell leukemia Plasma cell leukemia Leukemic phase of indolent non-Hodgkin lymphoma
T cell lymphoid leukemia
T- cll T- Prolymphocytic leukemia Sezary syndrome Adult T cell leukemia Large granular lymphocytic leukemia Large cell lymphoma/ leukemia
Which type of chronic lymphoid leukemia Half tendency to infiltrate the skin , are more aggressive and have a shorter course
T lymphoid leukemia
T-CLL prognosis
Very bad , difficult to treat
What do you see an histology of chronic lymphoid leukemia
Smear cell
What is B -CLL
Progressive accumulation of immunologically incompetent lymphocytes
Distribution of B-CLL in bone marrow
Interstitial, nodular , diffuse
Progression of b-cll
Start in lymph node or bone marrow and expand to other hematopoietic organs
Sex ratio B-CLL
M:F 2:1
Percentage of b-cll in all leukemia
25% leukemias
Main age affected by b cll and cll
45-70
40 for Ghanaians
Markers found in lymphocytes of cll
CD23
CD25
CD27
Genes involved in cll
Up regulation of anti apoptotic protein. - BCL2, MCL1, survivin
TNF alpha constantly expressed
Complications of Cll
Involvement of all lymphoid organs Massive splenomegaly Immune Paresis , recurrent infection Auto immune hemolytic anemia Immune thrombocytopenic purpura Cytopeniaz
Where is there anemias and thrombocytopenia in cll
Autoimmune phenomena
Marrow suppression of red cell and megakaryocyte
Hypersplenism
Can CLL become large cell lymphoma
Yes , bad prognosis
Clinical presentation of cll
Incidental discovery
Superficial lymph node enlargements
Anemia
Splenomegaly
Sometimes hemorrhage, aiha, mediastinal pressure, reduced gamma
Globulin, thrombocytopenia
Diagnosis of cll
FBC , blood film - lymphocytosis LFT, bue, cr Bone marrow trephine Immunohistochemistry and histology Immunogentics Cytogenetic Imaging
Cll diagnostic criteria
Monoclonal lymphocyte count more than 5x10^9 /l
Cd5+ and cd23+ of cll
Cd19+ , cd209
Weak or negative FMC7 , CD79b
Staging cll accepted
RAI
BINNET
BINNET staging
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
Treatment
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)
