Christie Asleson

Hematology/Immunology

CLL- Chronic Lymphocytic Leukemia

• Chronic lymphocytic leukemia (CLL) is cancer of the blood and bone marrow.

• The term "chronic" comes from that it progresses more slowly than other types  of leukemia. The term "lymphocytic" comes from the cells affected by the disease

Overview

• 15,000 ppl each year in the United States

• It is the most common type of leukemia in adults.

• Most of  those who get it are older than 55.

• Average age is 72

• More common in men 

•  In some people can remain slow-growing for years and never need treatment.      

Overview

• Lymphocytes evolve from immature cells called hematopoietic stem cells.

• Healthy lymphocytes evolve through their life cycle eventually die.

• In CLL, changes in the diseased cells prevent them from maturing properly.

• They have a longer life span.

• Over time, accumulate in the bone marrow and in the tissues of the lymphatic system

• Interfering with other immune system functions.

How it develops

Many people with chronic lymphocytic leukemia have no symptoms. Those who do develop signs and symptoms may experience:

• Enlarged, but painless, lymph nodes

• Fatigue

• Fever

• Nigh sweats t 

• Weight loss  • Frequent infection  Pain in the upper left portion of

the abdomen, which may be caused by an enlarge

spleen n

Symptoms

• Inherited or genetics, traits and exposure to cancer-causing agents in the environment.

• Relatives such as a parent, child, or sibling, with CLL

• Most cases its associated with specific gene mutation

Risk Factors

• Many types of tests are performed

• Tests can reveal abnormatlities in cells

• Amount of blood cells

• Changes in bone marrow

• Other factors in deciding the course of treatment

Common Tests Used:

Cytogenetic studies, Immunohisto-chemistry studies,Flow cytometry, and  Molecular genetic studies

Diagnosis

In the Blood Blood Test

• Complete Blood Count

• Low numbers of RBC

• Platelet levels low

• Normal WBC levels diminished

Diagnosis cont.

Bone Marrow Aspirates & Biopsies

Physical Examination

Doctor will check:

• Lymph Nodes

• Spleen

• Liver

First sign can be enlarged spleen or liver

• Bone Marrow biopsies- remove small peice of bone and marrow for examination

• Aspirate- Withdraw Small sample of liquid bone marrow

Diagnosis cont.

• Classify or stage each patients CLL according to how far the disease has progressed

• Rai System

• Stage 0

• Stage I

• Stage II

• Stage III

• Stage IV

Classification

• No treatment yet that is considered a cure

• They are designed to slow progression of disease

• CLL develops very slowly

Treatment

Radiation Therapy

• Used in rare cases

• Uses high-energy rays

• Destroys cancer cells

• Controls enlarged lymph nodes or spleen

Treatment Cont.

Stem Cell Transplant

• For some patients

• Obtain stem cells by filtering from blood stream

• Then treated with high-dose of chemo.

• Doctors then transplant harvest stem cells

Treatment Cont.

On going Care:

People with CLL are likely to see their physician often to monitor the disease and to determine if it is progressing.

 These check-ups may include a physical exam, blood tests, bone marrow aspirates, biopsies, and radiographic studies.

Treatment Cont.

• Out come depends on a few things

• Change in DNA?

• Lymphocytes spread throughout bone marrow?

• The Stage of CLL

• Treatment helping or not?

• General Health

Prognosis

• 5 year Survival rate

• Treatment and responses to treatment vary greatly

• The five-year relative CLL survival rates by race and sex were:

~ 74.3% for Caucasian men 

~ 77.1% for Caucasian women

 ~53.8% for African American men

~ 62.2 %for African American women.

 

Prognosis: What are the Survival Rates?

The End