CLL Flashcards
What are smear cells?
Smear cells are produced during spreading of the blood film due to the fragility of lymphocytes.
In Chronic Lymphocytic Leukaemia (CLL), what percentage of lymphocytes are prolymphocytes in the CLL/PLL category?
In CLL/PLL, >10% (but <55%) of cells are prolymphocytes.
What type of anaemia is usually seen in CLL?
Anaemia is usually normocytic normochromic.
What are the laboratory features of lymphocytes in CLL?
Lymphocytes are small in size with thin rim of slightly basophilic or clear agranular cytoplasm and coarse condensed nuclear chromatin with no nucleoli.
What are the characteristic immunophenotyping markers expressed by CLL cells?
CLL cells characteristically express CD19, CD5, CD23, weak surface membrane immunoglobulin, and a single light chain (either κ or λ).
What are the four possible patterns of bone marrow infiltration in CLL?
- Interstitial
- Diffuse
- Nodular
- Mixed
What are the common chromosomal abnormalities associated with CLL?
- Deletion of 13q14
- Trisomy 12
- Deletion at 11q23
- 17p deletion
What are some causes of anaemia in CLL?
- Progressive marrow replacement by tumor cells
- Autoimmune haemolytic anaemia
- Hypersplenism
What are the causes of thrombocytopenia in CLL?
- Progressive marrow replacement by tumor cells
- Immune destruction of platelets
- Hypersplenism
What are the two staging systems used for CLL?
- Rai staging system
- Binet staging system
Is Chronic Lymphocytic Leukaemia (CLL) usually curable?
No, CLL is not usually curable but can be controlled for many years.
What is a differential diagnosis for CLL associated with viral infections?
Reactive lymphocytosis is seen in viral infections such as Epstein-Barr virus, cytomegalovirus, hepatitis, influenza.
What characterizes Prolymphocytic Leukaemia (PLL)?
PLL is characterized by massive splenomegaly, no lymphadenopathy, marked lymphocytosis, and predominance of prolymphocytes in peripheral blood (>55%).
What are some complications associated with CLL?
- Increased risk of infections
- Autoimmune haemolytic anaemia
- Immune thrombocytopenia
- Increased risk of second malignancies
- Aggressive transformation
What is Richter’s syndrome?
Richter’s syndrome is the development of a diffuse large cell lymphoma in a patient with pre-existing CLL.
What are the criteria for treatment in CLL?
- Enlarging, symptomatic lymph nodes > 10 cm
- Enlarging, symptomatic spleen > 6 cm below the left costal margin
- Constitutional symptoms (e.g. fatigue, B symptoms)
- Cytopenias due to CLL
- Poorly controlled autoimmune haemolytic anaemia
- Progressive lymphocytosis
What is the male to female ratio in CLL prevalence?
The male to female ratio is 2:1.
What is the peak incidence age range for CLL?
The peak incidence is between 60 and 80 years.
What is the treatment option for first-line young/fit patients without del 17p?
- FCR (fludarabine + cyclophosphamide + rituximab)
- BR (bendamustine + rituximab)
- FR (fludarabine + rituximab)
- PCR (pentostatin + cyclophosphamide + rituximab)
- Obinutuzumab + chlorambucil
What is a significant feature of CLL cells in terms of apoptosis?
CLL cells typically exhibit impaired apoptosis and a prolonged lifespan.
What is the absolute lymphocyte count indicative of lymphocytosis in CLL?
Absolute lymphocyte count is > 5 x 10^9/L.
True or False: Small lymphocytic lymphoma (SLL) has a higher circulating monoclonal B cell count than CLL.
False.
Fill in the blank: The aetiology of CLL is ______.
unknown
What is the immunotherapy approach that may correct immune dysregulation in CLL?
Checkpoint inhibition may result in correction of immune dysregulation and an anti-leukemia effect.
What is the risk factor associated with family history in CLL?
There is a sevenfold increased risk of CLL in close relatives of patients.
