Presentation
These updated ESMO Clinical Practice Guidelines present the latest information on CLL including the diagnosis and molecular biology of CLL and treatment strategies for early and advanced disease. Download the PDF from Annals of Oncology [esmo.org]
A key challenge presented by intratumoral heterogeneity is its capacity to fuel clonal evolution and the generation of therapy resistant subpopulations. [bloodjournal.org]
Thus, CLL may present in individuals with a long history of having high-count CLL/SLL MBL. [en.wikipedia.org]
Assessment of reticulocyte count, ferritin, iron saturation, vitamin B 12, and folate and correction of nutritional deficiencies if present is recommended for patients with grade 3/4 anemia. [jnccn.org]
Immune System
- Splenomegaly
[…] with or without lymphadenopathy Stage III : characterized by absolute lymphocytosis and anemia (hemoglobin Stage IV : characterized by absolute lymphocytosis and thrombocytopenia ( 3 ) with or without lymphadenopathy, hepatomegaly, splenomegaly, or anemia [en.wikipedia.org]
Entire Body System
- Fatigue
[…] myeloid leukemia USMLE® Step 2 style questions 2 questions Chronic lymphoid leukemia USMLE® Step 1 style questions 2 questions Chronic lymphoid leukemia USMLE® Step 2 style questions 2 questions Preview A 71-year-old man comes to the clinic because of fatigue [osmosis.org]
Imatinib: Chronic fatigue (mostly correlated with musculoskeletal pain and muscular cramps) is a major factor reducing quality of life. 47 Hypophosphatemia and decrease in bone mineral density has been noted in a small group of patients, suggesting that [jnccn.org]
- Weakness
In some individuals, the disease comes to light only after the cancerous cells overwhelm the bone marrow resulting in anemia producing tiredness or weakness. [en.wikipedia.org]
[…] or CYP3A5 inducers may decrease the therapeutic plasma concentration of TKIs, whereas CYP3A4 inhibitors and drugs that are metabolized by the CYP3A4 or CYP3A5 enzyme might result in increased plasma levels of TKIs. 109 In addition, imatinib is also a weak [jnccn.org]
- Recurrent Infection
infection, warm autoimmune hemolytic anemia in 10–15% of patients, and bone marrow failure. [en.wikipedia.org]
- Weight Loss
Chronic lymphocytic leukemia Other names B-cell chronic lymphocytic leukemia (B-CLL) [1] Peripheral blood smear showing CLL cells Specialty Hematology and oncology Symptoms Early : None [2] Later : Non-painful lymph nodes swelling, feeling tired, fever, weight [en.wikipedia.org]
- Fever
Chronic lymphocytic leukemia Other names B-cell chronic lymphocytic leukemia (B-CLL) [1] Peripheral blood smear showing CLL cells Specialty Hematology and oncology Symptoms Early : None [2] Later : Non-painful lymph nodes swelling, feeling tired, fever [en.wikipedia.org]
Workup
Diagnosis and Workup Initial evaluation should consist of a history and physical exam, including palpation of spleen, Download Figure NCCN Clinical Practice Guidelines in Oncology : Chronic Myeloid Leukemia, Version 1.2019 Version 1.2019, 08-01-18 ©2018 [jnccn.org]
Serum
- Lymphocytosis
CLL is, in virtually all cases, preceded by a particular subtype of monoclonal B-cell lymphocytosis (MBL). [en.wikipedia.org]
CLL like monoclonal B-cell lymphocytosis: are we all bound to have it? Cancer Biol. 2010; 20 :384–390. doi: 10.1016/j.semcancer.2010.08.005. [ PubMed ] [ CrossRef ] [ Google Scholar ] 4. Kem W, Bacher U, Haferlach C, Dicker F, et al. [ncbi.nlm.nih.gov]
[…] studies, which have used longitudinal follow-up of the subclonal composition by various genomic technologies and have illustrated the patterns of clonal evolution across the natural history of CLL ( Figure 3C ). 12, 48, 58 ⇓ ⇓ - 61 Monoclonal B-cell lymphocytosis [bloodjournal.org]
- Cytopenia
Do regulatory T cells have a role in disease progression and autoimmune cytopenias of chronic lymphocytic leukemia? (Abstract) Blood. 2011; 118 :3864. [ Google Scholar ] 22. Hallek M, Cheson BD, Catovsky D, et al. [ncbi.nlm.nih.gov]
However, no hepatotoxicity-related fatalities occurred during the study. 42 Management of Hematologic Toxicities of TKI Therapy: Cytopenias (anemia, neutropenia, and thrombocytopenia) should be managed with transient interruptions of TKI therapy and dose [jnccn.org]
Treatment
Treatment [ edit ] CLL treatment focuses on controlling the disease and its symptoms rather than on an outright cure. [en.wikipedia.org]
Alternate treatment options should be considered as described subsequently. [jnccn.org]
Rituximab in combination with high dose methylprednisolone for the treatment of fludarabine refractory high risk chronic lymphocytic leukemia. [ncbi.nlm.nih.gov]
These updated ESMO Clinical Practice Guidelines present the latest information on CLL including the diagnosis and molecular biology of CLL and treatment strategies for early and advanced disease. Download the PDF from Annals of Oncology [esmo.org]
For more than a decade, “watch and wait” has been the standard approach for patients without symptomatic disease, with frontline chemotherapy-based therapy as the conventional choice if treatment is required. [bloodjournal.org]
Prognosis
The distinction is important as the prognosis and therapy differ from CLL. [en.wikipedia.org]
Evidence for a macromolecular complex in poor prognosis CLL that contains CD38, CD49d, CD44 and MMP-9. Br J Haematol. 2011;154:216-22. [ Links ] Zhang S, Wu CCN, Fecteau J-F, Cui B, Chen L, Zhang R, et al. [medigraphic.com]
Previous work suggested that the overall prognosis of Ph-negative CML with clonal evolution is good and is dependent on response to imatinib therapy. 21 Recently, however, the presence of chromosome abnormalities other than loss of Y chromosome has been [jnccn.org]
ZAP-70 expression and prognosis in chronic lymphocytic leukaemia. Lancet. 2004; 363 :105–111. doi: 10.1016/S0140-6736(03)15260-9. [ PubMed ] [ CrossRef ] [ Google Scholar ] 20. Crespo M, Bosch F, Villamor N, et al. [ncbi.nlm.nih.gov]
Incorporating evolutionary concepts into schema for CLL prognosis, monitoring, and treatment The tracking of intratumoral heterogeneity over time can provide critical information on clonal dynamics, which could impact the management of patients. [bloodjournal.org]
Etiology
[…] and UK NCRN CLL201 and CLL202. 36 DCFI, Dana-Farber Cancer Institute; ERIC, European Research Initiative on CLL; GCFLLC/MW-GOELAMS, French CLL Intergroup; GCLLSG, German CLL Study Group; MLL, Munich Leukemia Laboratory; SCALE, Scandinavian Lymphoma Etiology [bloodjournal.org]
Epidemiology
[…] subtypes have a median survival of 6–8 years, while others have a median survival of 22 years (which is a normal lifespan for older patients). [ citation needed ] Telomere length has been suggested to be a valuable prognostic indicator of survival. [53] Epidemiology [en.wikipedia.org]
Prevention
Thus, as an “adaptive therapy” strategy, 90 a key goal would be to maintain subclonal relationships such that the emergence of the more resistant clones is prevented. [bloodjournal.org]
[…] bosutinib, 400 mg daily) are all appropriate options for first-line TKI therapy for patients with CP-CML across all risk scores (see CML-2; page 1112). 39 – 42 Disease progression is more frequent in patients with intermediate- or high-risk score, and prevention [jnccn.org]