Nikcevich- CLL Cases Flashcards
What is the most common leukemia in adults? What is the median age of diagnosis and survival?
Chronic lymphocytic leukemia
65
9 yrs
What is the only curative therapy for CLL?
allogenic stem cell transplant
What is CLL?
Uncontrolled clonal accumulation of mature lymphocytes
assoicated w/ mutated IgVh genes
If you were using flow cytometry to diagnose a case of CLL what CD markers would you be looking for?
CD5
CD19
CD20
CD23
What CDs are associated w/ mantle cell lymphoma?
CD5
CD23
cyclin D
What is a DDX for CLL?
Follicular lymphoma mantle cell lymphoma (distinguished by CD) Prolymphocytic leukemia SLVL HCL
CLL is often an _________dx in a _______pt.
incidental
asymptomatic pt
Progressive adenopathy and bone marrow involvement correlates with what sxs in CLL?
fatigue, malaie, weight loss, fevers
Severe cytopenias, increased risk of infection
What are the long term complicatoins of CLL?
Autoimmne sequelae
Richter’s transformation
What autoimmune complications are associated w/ CLL?
AIHA
Pure red cell aplasia
ITP
Neutropenia
What are the Rai system stages?
0-lymphocytosis 1-lymphadenopathy 2- splenomegaly 3- HgB < 11 4- platelets < 100K
What are the Binet system stages?
A- lymphocytosis and 1-3 sites lymphadenopathy
B- lymphocytosis w/ >3 sites lymphadenopathy
C- lymhphocytois + anemia/thrombocytosis
What is the median survival for CLL?
> 10 years
What are poor prognostic factors for CLL?
Advanced stage at dx Rapid lymphocyte doubling time diffuse marrow infiltration advanced age/M Elevated b2 microglobulin, soluble CD23
What CD is associated w/ poor prognosis?
CD23
ZAP 70
What are cytogenetic abnormalities are associated w/ CLL?
13q
Trisoy 12
11q
17p
**ALWAYS get FISH studies w/ CLL
CD38 can be a surrogate marker for Ig gene mutations. You can detect via flow cytometry!
CD38+ and CD38- are associated w/ what prognosis? survival?
CD38+ unmutated Ig gene mutations= poor prognosis (9 year survival)
CD38- mutated Ig genes= better prognosis (>20 yrs survival)
ZAP 70 expression correlates w/ what CD expression/prognosis?
CD38 expression
POOR prognosis
**correlates w/ IgVh gene mutations
When should you treat CLL?
When there is progressive lymphocytosis, lymphadenopathy, splenomegaly, obne marrow failure
What are the tx options for CLL?
Corticosteroids
Alkylating agents
What nucleoside analogs can be used to tx CLL?
FLudarabine
Pentostatin
What monoclonal antibodies can be used to tx CLL?
Rituximab (anti-CD20)
Ofatumumuab (anti-CD 20)
What combination chemo is used to tx CLL?
PCR
FCR
How do you treat younger pts w/ CLL?
Clinical trial
PCR/FCR
Bendamustine plus rituximab
Ibrutinib
How do you treat older, more frail pts?
Chlorambucil +/- prednisone
Bendamustine plus rituximab
Ibrutinib
What is the only curative modality for CLL?
allogenic transplant
need matched-sib donor
substantial morbidity/mortality
What is the price of curing CLL?
GVHD
