chronic lymphocytoc leukaemia

Question 1

cells

Answer 1

Malignancy of small B lymphocytes

Question 2

epidemiology

Answer 2

1% all UK cancers - ~4000/yr
Peak incidence 60-80
M:F – 2:1

Question 3

risk factors

Answer 3

No specific risk factors
17p deletion/TP53 mutation
Used to convey worse prognosis

Question 4

lymph nodes or bone marrow

Answer 4

affecting lymph nodes with <5x109 lymphocytes on FBC

Question 5

Common presentations

Answer 5

ASYMPTOMATIC LYMPHOCYTOSIS
>80% patients diagnosed this way

B symptoms:
- Fever >38 degrees >2 weeks unexplained
- Drenching sweats > 4 weeks unexplained
- Weight loss >10% in 6 months

Lymphadenopathy/ organomegaly and cytopenias as disease progresses

Autoimmune phenomena
Autoimmune haemolytic anaemia
Immune thrombocytopenia

Question 6

diagnostic test

Answer 6

Peripheral blood FLOW CYTOMETRY
>5 x 109 lymphs >3 months + characteristic pattern of cell markers

Question 7

treatment - rule of 3

Answer 7

Rule of 3
– approx. 1 in 3 need treatment soon, 1 in 3 need treatment later, 1 in 3 never treated
“Chemotherapy free” treatment regimes

Question 8

when would you treat

Answer 8

Treat if problematic:
B symptoms, severe cytopenias, refractory immune complications, symptomatic/bulky organomegaly or lymphadenopathy, rapidly doubling lymphocyte count

Question 9

Binet staging system

Answer 9

Based on clinical examination of neck/axillae/groin/liver/spleen
A - <3 areas lymph node enlargement
B – 3-5 areas
C – Hb <100 or plts <100
Stage C – indication for treatment