Chronic Lymphocytic Leukemia (CLL) - Summary
Overview:
• Most common leukemia in adults
• Disorder of morphologically mature B Lymphocytes
• Median survival 4-6 years but >10 years in patients with minimal tumor burden
Diagnosis:
• Peripheral smear → small rnature-appearing lymphocytes, smudge cells are characteristic
• Peripheral flow cytometry → >500/uL clonal B lymphocytes with typical immunophenotype
Clinical Manifestations:
1) Incidental detection of Vmphocytosis on routine CBC (rnost common)
2) Asymptomatic lymphadenopathy
3) B symptoms → fevers, night sweats, weight loss
4) Splenomegaly
5) Symptoms of anemia or thrombocytopenia
Complications:
1) Infection due to hypogammaglobulinemia
2) Autoimmune cytopenias (ITP, AIHA, PRCA, autoimmune neutropenia)
3) Transformation to large cell lymphoma (Richter transformation)
Treatment:
• "Watchful Waiting" →several RCTs have found no benefit of immediate chemotherapy for low-risk disease
• Indications for Treatment:
- Constitutional symptoms
- Symptomatic massive lymphadenopathy and/or splenomegaly
- Progressive bore marrow failure with anemia or thrombocytopenia
- Lymphocyte doubling time < 6 months
- Autoimmune cytopenias (ITP. AIHA, PRCA)
• Treatment Agents:
1) Alkylating agents (bendamustine, chlorambucil)
2) Purine analogs (fludarabine)
3) Monoclonal antibodies (rituximab, obinutuzumab)
4) Ibrutinib (Bruton kinase inhibitor)
5) Venetoclax (BCL2 inhibitor)
by Lauren Banaszak, MD @LaurenBzak via @uw_IMresidency
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