Chronic Lymphocytic Leukemia

Question 1

definition of CLL

Answer 1

• stem cell derived leukemia
• ## disease of the elderly (72+).

Question 2

morphological features of CLL

Answer 2

• Cell of origin in CLL is a hematopoietic stem cell (CD34+, CD38-) this can develop clonal B cells

• Step 1: generation of CD5+ lymphocytes involves expansion via antigenic stimulation by BCR
• Step 2: oligo-clonal expansion (B cells). Here mutations of ATM/ miRNA15a/SF3B1 are responsible for the expansion.

Question 3

clinical features of CLL

Answer 3

• lymphadenopathy
• splenomegaly
• bone marrow infiltration

Question 4

classification of CLL

Answer 4

• RAI

- BINET

Question 5

diagnostic path to reach clinical action

Answer 5

• blood smear: small mature lymphocytes, dense nucleus, no nuclei
• pro lymphocytes present (>55%)
• gumprecht shadows and smudge cells
• marrow biopsy before treatment start
• immunoglobin light chain test

Question 6

Which chr do we look at in a FISH analysis for CLL

Answer 6

deletion of ch 17

• deletion for ch 11
• trisomy 21
• deletion of ch13 (most common)

Question 7

main therapeutic options of CLL

Answer 7

FCR for those with mutated IgHv

- ibrutinib