CLL

Question 1

What category does Chronic Lymphocytic Leukemia fall into??

Answer 1

Chronic Lymphoproliferative Disorders

Question 2

What must you know about chronic lymphoproliferative disorders

Answer 2

• Malignant proliferation of lymphocytes in blood, bone marrow
• Many disorders; CLL most important
• Occur ONLY in adults
• Long course; indolent (not very rapidly dividing) but incurable
• Can’t really do bone marrow transplant (where you expect to cure the patient — but you might be able to do allogenic transplant) —> cancer could just hang out in the lymph nodes

Question 3

What things should you know about chronic lymphocytic leukemia?

Answer 3

• Small, mature lymphocytes
• = small lymphocytic lymphoma
• B-cell, but CD5+ (weird!)
• Long but inexorable course

Question 4

What are the clinical findings in CLL?

Answer 4

• Older
• Asymptomatic at first
• Later, organ infiltration

Question 5

What is the immunophenotype for CLL (EXAM!) ?

Answer 5

Positive: B-cell antigens, T-cell antigen (CD5)!
Negative: TdT

Question 6

What are the laboratory findings in CLL?

Answer 6

• WBC high or really really high

- Hypogammaglobulinemia (causes infection bc they can’t make Ig/antibodies like they need to)

Question 7

What is the pathophysiology of CLL?

Answer 7

• bcl-2 gene rearrangement

- normal bcl-2 prevents apoptosis

Question 8

How to treat CLL?

Answer 8

• Conservative

- Reduce organomegaly, infections (vaccinate, etc.)

Question 9

What is the prognosis of CLL?

Answer 9

• “Counts” adenopathy
• BM pattern, chromosomal abnormalities
• Mean survival: 9 years
• Death usually from infection

Question 10

What things MUST you know about Hairy Cell Leukemia? (EXAM)

Answer 10

• Hairy cells
• Splenomegaly (HUGE SPLEEN) without lymphadenopathy
• Pancytopenia
• TRAP +

Question 11

What are the clinical findings of HCL?

Answer 11

• Older (>40)
• M:F = 5:1
• Big spleen but no lymphadenopathy

Question 12

What are some special studies in HCL?

Answer 12

1. Cytochemistry
   - TRAP +
2. Immunophenotype (replacing cytochemistry)
   - Positive for B-cell antigens, CD25, CD11c
   - Negative for CD5

Question 13

What are laboratory findings in HCL?

Answer 13

• Pancytopenia (usually)

- Monocytopenia (always) = almost never any monocytes around

Question 14

What is the treatment for HCL?

Answer 14

Chemotherapy

Question 15

What is the prognosis for HCL?

Answer 15

Good!!

Question 16

What things MUST you know about prolymphocytic leukemia?

Answer 16

• Prolymphocytes
• Splenomegaly without lymphadenopathy
• Rare
• Aggressive

Question 17

What are the clinical findings in PL?

Answer 17

• Splenomegaly without lymphadenopathy

- Aggressive

Question 18

What are the laboratory findings in PL?

Answer 18

• VERY high WBC
• High Hgb
• Low platelet count

Question 19

What MUST you know about Large Granulated Lymphocyte Leukemia?

Answer 19

• Large granulated lymphocytes
• T-cell
• Neutropenia
• Long survival

Question 20

What are the clinical findings in LGL?

Answer 20

• Infections (from neutropenia)

- Long survival

Question 21

What is the immunophenotype in LGL?

Answer 21

-T-cell

Question 22

What are the laboratory findings in LGL?

Answer 22

• Modest high WBC

- Neutropenia