Symposia: CLL Flashcards

1
Q

What is leukaemia?

A

A form of blood cancer that arises due to a failure of haematopoietic differentiation

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2
Q

How is CLL diagnosed?

A
  1. Enlarged lymph nodes, and anaemia and/or bruising resulting from a low platelet count.
  2. Lymphocytes expressing CD5+ and CD19+ antigens!!!
  3. Additional protein markers: CD200, CD43, and ROR1.
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3
Q

What are the key prognostic tools used in the management of CLL?

A
  1. Binet/Rye Clinical Staging
  2. Lymphocyte doubling time (LDT)
  3. Immunoglobulin heavy chain gene mutation status
  4. CD38 expression
  5. CD49d expression (integrin which modulates adhesion quality of cells; high CD49d means cells can migrate and have a worser prognosis)
  6. Detection of P53 mutation or deletion
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4
Q

What are the features of Stage A CLL?

A

Confirmed diagnosis of CLL with a CD5+/CD19+ lymphocytosis of
>5 x 109/L

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5
Q

What are the features of Stage B CLL?

A

Same as Stage A PLUS at least 3 areas of palpable lymphoid tissue
enlargement

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6
Q

What are the features of Stage C CLL?

A

Same as Stage B PLUS Haemoglobin <100g/L or Platelet count <100/µL (both signify some degree of bone marrow failure).

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7
Q

What are the standard treatment options for patients with CLL?

A

Chemotherapy- typically targets DNA of rapidly dividing cells.
Chemoimmunotherapy- immunoglobulin antibody (Rituximab) which target CD20

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8
Q

Why is P53 important for the prognosis of CLL?

A

P53 is important in

determining the cellular response to DNA damage (including chemotherapy). Deletion or mutation confers poorer prognosis.

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9
Q

What are the first line treatment options for “fit”* patients without a P53 deletion/mutation?

A

Fludarabine + cyclophosphamide + rituximab (FCR)
or
Bendamustine + rituximab (BR)

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10
Q

What are the first line treatment options for “less fit” patients without a P53 deletion/mutation?

A

Chlorambucil + rituximab (CR)
or
Bendamustine + rituximab (BR)

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11
Q

What is rituximab?

A

Rituximab is a monoclonal antibody targeting CD20

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12
Q

What are the novel therapies for CLL?

A
  1. Ibrutinib (BTK inhibitor)
  2. Idelalisib (PI3K inhibitor)
  3. Venetoclax (BCL2 inhibitor)
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13
Q

What are the first line treatment options for patients with a P53 deletion/mutation?

A

Ibrutinib and venetoclax

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14
Q

What are the side effects of Ibrutinib?

A

Non-curative and causes a transient increase in peripheral blood lymphocytosis

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15
Q

What is CAR T?

A

Chimeric antigen receptor T cells

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16
Q

How does CAR T work?

A

CAR-T cell therapy uses T cells engineered with CARs for cancer therapy. T cells are modified to recognize cancer cells, especially CD19 on the surface of the tumour, in order to more effectively target and destroy them.