LEUCEMIE LIMFOIDA CRONICA

Question 1

LLC: Caract generale

Answer 1

• sindrom mieloproliferativ cronic, caracterizat prin plorif. clonala si acumularea de Ly cu aspect matur, dar functie imatura;
• initial in MOH si sange, apoi in ggl., splina, ficat etc.;

Question 1

LLC: frecventa:

Answer 1

• > 50-55 ani;
• creste cu varsta;
• mai predominant la barbati;

Question 2

LLC: Factori de risc:

Answer 2

• ag. chimici;
• ag. fizici;
• factori de mediu;
• inf. virale (HTLV-1, HTLV-2, EBV);

Question 3

LLC: Patogenie:

Answer 3

• fenotip: CD19, CD20, CD22, CD24, CD5, CD23;
• anomalii genetice: del(17p), del(11q);

Question 4

LLC: DIagnostic clinic:

Answer 4

• simptome: febra, astenie, scadere in greutate, transpiratii;
• poliadenopatii superficiale - generalizate, simetrice, elastice, mobile, nedureroase;
• splenomegalie moderata;
• hepatomegalie;
• hipertrofie amigdaliana;
• adenopatii profunde;

Question 5

LLC: Diagnostic paraclinic - hemograma:

Answer 5

• hiperleucocitoza;
• hiperlimfocitoza >5.000/mm3 -> umbre nucleare Gumprecht;
• anemie normocroma, normocitara;
• trombocitopenie;
• neutropenie;

Question 6

LLC: Diagnostic paraclinic - imunofenotiparea:

Answer 6

• esentiala pt diagnostic pozitiv:
• CD5+;
• CD23+;

Question 7

LLC: Diagnostic paraclinic - biopsia ganglionara:

Answer 7

• aspect de LMNH limfocitic;
• pentru suspiciunea de transformare in limfom agresiv;

Question 8

LLC: Diagnostic paraclinic - imunologie:

Answer 8

• hipogamaglobulinemie;
• anemie hemolitica autoimuna;
• trombocitopenie autoimuna;

Question 9

LLC: Diagnostic paraclinic - citogenetica si biologie moleculara:

Answer 9

• trisomia 12;
• del (13q);
• del (11q);
• del (17p);

Question 10

LLC: Diagnostic diferential:

Answer 10

• scorul MATUTES >=4 => LLC;

Question 11

LLC: Stadializarea RAI (5):

Answer 11

0 - limfocitoza (>5.000mm3);
I - 0 + adenopatii;
II - I + hepato-/splenomegalie;
III - II + anemie (Hb<11g/dL);
IV - limfocitoza + trombocitopenie (<100.000) +- adenopatii/spleno-/hepatomegalie;

Question 12

LLC: Factori de prognostic negativ:

Answer 12

• stadiu avansat;
• infiltratie medulara difuza;
• LDH crescut;
• del (17p), del (11q);
  timp de dublare a Ly <12 luni;

Question 13

LLC: Complicatii:

Answer 13

• infectioase;
• insuficienta medulara;
• autoimune (AHAI, GNA complexe imune);
• sdr. Richter (dezv. sec. a unei prolif. limf. maligne agresive);
• cancere solide secundare;

Question 14

LLC: Tratament: Indicatii:

Answer 14

• RAI III-IV;
• semne de insuf. medulara;
• splenomegalie;
• semne B;
• limfocitoza <250.000;

Question 15

LLC: Tratament:

Answer 15

• IBRUTINIB (inhibitor tirozin-kinaza Bruton - BTK);
• VENETOCLAX (inhibitor bcl-2) + OBINOTUZUMAB (mAc anti-CD20);
• +- citostatice;