Medical Archive

Introduction

Epidemiology

M/c adult leukemia.

Biology and pathophysiology

??? ???? ?? (B cell? monoclonal ??? 98%)

	CD5	CD10	CD19	CD20	CD23	CyclinD1	Surface Ig
CLL	+	?	+	+ (dim)	+	?	+ (dim)
Mantle cell lymphoma	+	?	+	+ (mod/bright)	?	+	+ (mod/bright)
Marginal zone lymphoma	?/+	?	+	+(mod/bright)	?/+	?	+ (mod/bright)
Follicular lymphoma	?	+	+	+	+	?

Clinical presentation and diagnosis of CLL

• Often asymptomatic
• Mild thrombocytopenia
• Anemia
  1. Immune dysregulation
  2. Formation of IgG autoantibodies against the erythrocyte membrane (warm agglutinins)
  3. RBCs coated with IgG are subsequently identified by the Fc receptor on splenic macrophages.
  4. Extravascular, immune-mediated hemolysis (ie, autoimmune hemolytic anemia)
• Lymphadenopathy
• Hepatosplenomegaly

Diagnosis

• CBC
  • Severe lymphocytosis
• PBS
  • Smudge cells
• Lymph node & BM biopsy
  • Not generally needed.
  • ??? ??? ?? >30%
• Flow cytometry
  • CD5, CD20? ??? ???? monoclonal, circulating naïve B cell
• Coomb’s test (+)

??	??? ?? >15,000/mm3 ?? (?? 5,000), “smudge””
??…	???, hepatosplenomagly
???	?? ?? ?  ???? ? ?? Hb<10 + ??? ??? <100,000

Complications of CLL

1. Infection
   • D/t hypogammaglobulinemia – m/c cause of death
2. Secondary malignancies
3. Autoimmune complications
   • Autoimmune hemolytic anemia (AIHA)
4. Richter’s transformation
   • Transformation to DLBL marked clinically by an enlarging lymph node or spleen
5. Atraumatic splenic rupture

Workup of CLL and approach to therapy

Staging

Criteria for the initiation of therapy

2? ?? B Sx
???>10cm, hepatosplenomegaly
WBC>30,000 2? ??
Anemia, thrombocytopenia (poorest prognosis)

Steroid? ?? ?? ?, ?? ??? ??? ?. ???
?????? ??? ??? ?? ?? ????

Initial therapy for CLL

Chlorambucil based Tx
Fludarabine based Tx (+rituximab)

• Leukapheresis (??? ?????)
  • ??, ???? ? ?? ?? ???.
  • ??? ???? ???? ?? ??.

Assessing response to therapy and minimal residual disease in CLL

Conclusion