CLL Part 2

Question 1

How is CLL diagnosed?

Answer 1

1) Blood Counts 2) Differential Counts 3) Blood smear 4) Immunophenotyping

Question 2

In the absence of lymphadenopathy/organomegaly, the presence of lymphocytes is with

Answer 2

Monoclonal B lymphocytosis

Question 3

What are the differential diagnosis for CLL?

Answer 3

Hairy Cell leukemia Leukemic manifestations of: - Mantle Cell lymphoma - MZL - splenic MZL with circulating villus lymphocytes - follicular lymphoma T-CLL = T-cell prolymphocytic leukemia (T-cell PLL) B-Cell PLL = >55% pro lymphocytes = prolymphocytic leukemia

Question 4

Tell me about the Rai staging system

Answer 4

There are 5 stages. 0 to IV Correlates with median survival Stage 0 (low risk) = lymphocytosis only. = 11.5 y Stage I (intermediate risk) = Lymphocytosis and lymphadenopathy = 11y Stage II (Intermediate risk) = 8 y Lymphocytosis in blood and marrow With Splenomegaly +/- hepatomegaly +/- lymphadenopathy Stage III (high risk) = 5 y Lymphocytosis and anemia. Hb

Question 5

Tell me about he Binet staging

Answer 5

3 stages, A - C, correlates with median survival A = 11.5 y Enlargement of

Question 6

What are the CLL indicators for treatment

Answer 6

(B.L.O.O.D L.A.I.R) B Symptoms - Fatigue, night sweats, LOW, fever L ymphocytosis increasing (Increase >50% over 2m) O rganomegaly (massive or progressive/spleen >6cm) O rgan function threatened (including BM failure) D oubling time of lymphocytes in 6months or less L ymph nodes bulky (>10cm) A AI complications that are not steroid-responsive I nfections becoming recurrent R ichter transformation

Question 7

What are the novel high -risk parameters of CLL?

Answer 7

Expression of ZAP-70 (>20%) Expression of CD 38 (30% or more) Chromosomal aberrations by FISH Unmutated IgVH

Question 8

Tell me about the Rai and Binet Staging