Chronic Lymphocytic Leukemia Cases Flashcards
What’s the typical presentation on flow cytometry for CLL?
CD5+, CD19+, CD20+, CD23+
What’s the difference betwee CLL and SLL?
No real difference - SLL is just the tissue phase of CLL
What’s the usual presentation of CLL?
often an incidental diagnosis in asymptomati patient
indolent disease is common
progressive adenopathy often correlates with symptoms of fatigue, malaise and weight loss
bone marrow involvement will lead to severe cytopenias and increased infection risk
What are some of the autoimmune complications of CLL?
autoimmune hemolytic anemia (often after disease has been treated)
pure red cell aplasia
ITP
Neutrpenia
WHat are the poor prognostic factors in CLL?
advanced stage dapid lymphocyte doubling time diffuse marrow infiltration advanced age/male gender CLL with PLL - secondary abnormal karyotype elevated b2 microglobulin and soluble CD23 CD38+ ZAP 70+
What are the cytogentic abnormalities in CLL in order from best prognosis ro worse prognosis?
13q- Normal karyotype trisomy 12 11q- 17 p- : thi sone's really bad
Why do you ALWAYS do a cytogenetics FISH on CLL?
Because if helps with prognosis and may help decide treatment (although doesn’t really tell you when to start treatment)
Why is “mutated” a better prognosis than unmutated in CLL?
Because the mutations typically involved IgH chains, which are supposed to be mutated anyway - somatic hypermutation
If your lab can’t test for mutations in IgH, what marker can you use for absence of mutation?
CD38+ - poor prognosis
or ZAP-70, but we don’t use that one anymore
When do you decide to treat CLL?
When there’s constitutional symptoms, progressive lymphocytosis, progressive lymphadenopathy, progressive splenomegaly, bone marrow failure, autoimmue complications, richter’s transformation, or the patient’s just unconfortable with the idea of not being treated for a leukemia
