Podcast
Questions and Answers
What is the median age at diagnosis of chronic lymphocytic leukemia (CLL)?
What is the median age at diagnosis of chronic lymphocytic leukemia (CLL)?
What is the characteristic feature of a peripheral smear in a patient with CLL?
What is the characteristic feature of a peripheral smear in a patient with CLL?
Which of the following is NOT a characteristic feature of CLL?
Which of the following is NOT a characteristic feature of CLL?
What is the typical lymphocyte count in peripheral blood of a patient with CLL?
What is the typical lymphocyte count in peripheral blood of a patient with CLL?
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Which of the following describes a significant finding in the bone marrow of a patient with CLL?
Which of the following describes a significant finding in the bone marrow of a patient with CLL?
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What is the role of flow cytometry in the diagnosis of CLL?
What is the role of flow cytometry in the diagnosis of CLL?
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What is the typical finding of immunophenotyping in patients with CLL?
What is the typical finding of immunophenotyping in patients with CLL?
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Which of the following is a major factor influencing the prognosis of CLL?
Which of the following is a major factor influencing the prognosis of CLL?
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Which of these features may be observed in the chronic stage of CML?
Which of these features may be observed in the chronic stage of CML?
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What is the typical range of white blood cell count in the chronic stage of CML?
What is the typical range of white blood cell count in the chronic stage of CML?
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What is the characteristic cytogenetic finding in CML?
What is the characteristic cytogenetic finding in CML?
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What is the most common presenting stage of CML?
What is the most common presenting stage of CML?
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Which of these findings is NOT part of a typical peripheral blood smear in CML?
Which of these findings is NOT part of a typical peripheral blood smear in CML?
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What is the typical median survival time for patients with CML without treatment?
What is the typical median survival time for patients with CML without treatment?
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What clinical symptom is NOT directly linked to hyperuricemia in CML?
What clinical symptom is NOT directly linked to hyperuricemia in CML?
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Study Notes
Leukemia-II
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Overview of chronic leukemia
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Chronic lymphocytic leukemia (CLL)
- Definition: Monoclonal disorder with progressive accumulation of functionally incompetent mature B lymphocytes.
- Accumulation sites: Bone marrow, blood, liver, spleen, and lymph nodes.
- Epidemiology: Median age at diagnosis is 60 years; 2:1 male predominance.
- Clinical features: Generalized lymphadenopathy (enlarged lymph nodes), hepatosplenomegaly (enlarged liver and spleen) in 50-60% of cases, anemia, thrombocytopenia (low platelet count) leading to bruising/purpura, and hypogammaglobulinemia (increased risk of infections).
- Diagnosis criteria (NCCN): Peripheral blood lymphocyte count of ≥5000/µL (normal 1000-3000/µL), small mature lymphocytes with high nucleus-to-cytoplasm ratio (N/C), round to oval nuclei with clumped chromatin, clonality confirmed by flow cytometry, and immunophenotyping showing CD19, CD20, CD23.
- Laboratory findings: Elevated WBCs (>100,000/dL), predominantly lymphocytes, anemia, and thrombocytopenia. Bone marrow shows mature B lymphocytic replacement. Immunophenotyping shows expression of CD19, CD20, CD23, and CD5.
- Prognosis: Dependent on the stage of the disease; two staging systems are used (Binet and Rai-Sawitsky).
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Chronic Myeloid Leukemia (CML)
- Definition: Neoplastic proliferation of the granulocytic cell line, without loss of differentiation capacity, characterized by the Philadelphia chromosome.
- Epidemiology: Primarily a disease of adults, but can occur in children and adolescents; peak incidence in the fifth to sixth decades of life.
- Stages: Chronic stage (85% of patients), accelerated stage, and acute blastic crisis.
- Chronic stage clinical features: Anemia, low-grade fever, fatigue, weight loss, loss of energy, night sweats, abdominal fullness (due to splenomegaly), left upper quadrant pain (from spleen infarction), hepatomegaly, easy bruising/spontaneous bleeding, and gout/renal impairment due to hyperuricemia (high uric acid).
- Laboratory findings (chronic stage): Markedly elevated WBCs (>100,000/dL), basophilia (important finding) and eosinophilia, anemia, thrombocytosis. Bone marrow hypercellular with increased myeloid cells, basophils, eosinophils, and megakaryocytes.
- Cytogenetic analysis: Necessary to detect the Philadelphia chromosome (reciprocal translocation between chromosome 9 and 22, t(9;22)(q34;q11)), leading to shortened chromosome 22.
- Prognosis: Slow progression; median survival roughly three years without treatment.
Case Studies
- Case Study 1: 72-year-old man with fatigue, weight loss, and lymphadenopathy, diagnosed with Chronic lymphocytic leukemia (CLL).
- Case Study 2: 64-year-old woman with abdominal discomfort, fatigue, and weight loss, diagnosed with Chronic myeloid leukemia (CML).
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Description
This quiz provides an in-depth overview of chronic leukemia, focusing specifically on chronic lymphocytic leukemia (CLL). It covers definitions, epidemiology, clinical features, diagnosis criteria, and laboratory findings. Test your knowledge on this important hematological condition.
