Symptoms and Stages of Chronic Lymphocytic Leukemia (CLL)

10 Questions

What are the two staging systems used to classify the progression of Chronic Lymphocytic Leukemia (CLL)?

Rai Staging System and Binet Staging System

What is the primary purpose of the watchful waiting approach in treating CLL?

Monitoring symptoms and blood counts

What is the primary mechanism of action of Ibrutinib, a targeted therapy used to treat CLL?

Inhibits BTK enzyme

What is the significance of the 17p deletion genetic mutation in CLL?

It has a poorer prognosis

What is the primary purpose of a bone marrow biopsy in the diagnosis of CLL?

To examine the bone marrow for CLL cells

What is the role of Rituximab in the treatment of CLL?

Targets CD20 protein

What are the three primary factors that affect the prognosis of CLL?

Age, Stage, and Genetic mutations

What is the purpose of immunophenotyping in the diagnosis of CLL?

To identify the specific type of CLL cells

What is the primary benefit of autologous stem cell transplantation in CLL?

To restore normal bone marrow function

What is the significance of anemia in the staging of CLL?

It is a characteristic of Stage III

Study Notes

Symptoms

Fatigue
Weight loss
Recurring infections
Enlarged lymph nodes
Enlarged liver or spleen
Easy bruising or bleeding
Frequent infections
Rash or skin lesions
Swollen or painful abdomen

Stages

Rai Staging System:
- Stage 0: CLL cells in blood and bone marrow only
- Stage I: Enlarged lymph nodes
- Stage II: Enlarged spleen
- Stage III: Anemia
- Stage IV: Low platelet count
Binet Staging System:
- Stage A: No anemia or thrombocytopenia
- Stage B: Anemia or thrombocytopenia
- Stage C: Anemia and thrombocytopenia

Prognosis

Median survival: 5-10 years
Factors affecting prognosis:
- Age: Older patients have poorer prognosis
- Stage: Advanced stages have poorer prognosis
- Genetic mutations: Certain mutations (e.g. 17p deletion) have poorer prognosis
- Treatment response: Patients responding to treatment have better prognosis

Treatment Options

Watchful waiting: Monitoring symptoms and blood counts
Chemotherapy:
- Chlorambucil
- Fludarabine
- Cyclophosphamide
Targeted therapy:
- Ibrutinib (inhibits BTK enzyme)
- Idelalisib (inhibits PI3K delta enzyme)
Immunotherapy:
- Rituximab (targets CD20 protein)
Stem cell transplantation: Autologous or allogenic transplantation
Clinical trials: Investigational treatments, such as CAR-T cell therapy

Diagnosis

Blood tests:
- Complete Blood Count (CBC)
- Peripheral blood smear
- Immunophenotyping (flow cytometry)
Bone marrow biopsy:
- Bone marrow aspiration
- Bone marrow biopsy
Imaging studies:
- CT scans
- PET scans
- Ultrasound
Lymph node biopsy: Excisional biopsy of enlarged lymph nodes

Symptoms of Chronic Lymphocytic Leukemia (CLL)

Fatigue is a common symptom of CLL
Weight loss is often associated with CLL
Recurring infections occur due to the impaired immune system
Enlarged lymph nodes, liver, or spleen can be a sign of CLL
Easy bruising or bleeding is a result of low platelet count
Frequent infections are a consequence of the weakened immune system
Rash or skin lesions may appear in some cases
Swollen or painful abdomen can occur due to enlarged spleen or liver

Rai Staging System for CLL

Stage 0: CLL cells are present only in the blood and bone marrow
Stage I: Enlarged lymph nodes are present
Stage II: Enlarged spleen is present
Stage III: Anemia is present
Stage IV: Low platelet count is present

Binet Staging System for CLL

Stage A: No anemia or thrombocytopenia is present
Stage B: Anemia or thrombocytopenia is present
Stage C: Both anemia and thrombocytopenia are present

Prognosis of CLL

Median survival rate is 5-10 years
Older patients have a poorer prognosis
Advanced stages of CLL have a poorer prognosis
Presence of certain genetic mutations (e.g. 17p deletion) worsens prognosis
Patients who respond well to treatment have a better prognosis

Treatment Options for CLL

Watchful waiting involves monitoring symptoms and blood counts
Chemotherapy options include chlorambucil, fludarabine, and cyclophosphamide
Targeted therapy options include ibrutinib (inhibits BTK enzyme) and idelalisib (inhibits PI3K delta enzyme)
Immunotherapy options include rituximab (targets CD20 protein)
Stem cell transplantation can be autologous or allogenic
Clinical trials offer investigational treatments, such as CAR-T cell therapy

Diagnosis of CLL

Blood tests include Complete Blood Count (CBC), peripheral blood smear, and immunophenotyping (flow cytometry)
Bone marrow biopsy involves bone marrow aspiration and biopsy
Imaging studies include CT scans, PET scans, and ultrasound
Lymph node biopsy involves excisional biopsy of enlarged lymph nodes