CLL Dr. Krafts 5/15/14

Question 1

Chronic lymphoproliferative disorders things you must know

Answer 1

• Malignant proliferation of lymphocytes in blood, bone marrow
• Many disorders; CLL most important
• Occur only in adults***
• Long course; indolent but incurable

Question 2

Chronic Lymphocytic Leukemia (most common)

Answer 2

• Small, mature lymphocytes
• = small lymphocytic lymphoma
• B-cell, but CD5+*** (weird!) (traditionally think of as a T-cell marker but present during a very short period during B cell development)
• Long but inexorable course

Question 3

Clinical findings in CLL

Answer 3

• Older (>40)
• Asymptomatic at first
• Later, organ infiltration
• Infection may occur due to hypogammaglobulinemia

Question 4

Immunophenotype of CLL

Answer 4

Positive for:

• B-cell antigens (CD20)***
• A T-cell antigen (CD5)***

Negative for:
-TdT (marker for lymphoblasts)(talking about mature here)

Question 5

Treatment and prognosis of CLL

Answer 5

Tx

• conservative
• reduce organomegaly, infections

Prognosis

• counts, adenopathy, BM pattern
• mean survival: 9 years
• death usually from infection

Question 6

Hairy Cell leukemia things you must know

Answer 6

• hairy cells
• splenomegaly w/o lymphadenopathy (usually they go together)
• pancytopenia
• TRAP +
• Chicken wire appearance in bone marrow (thats why you get pancytopenia)

Question 7

Clinical findings in HCL

Answer 7

older (>40)

M:F = 5:1***

big spleen but not lymphadenopahty

pancytopenia (usually) and monocytopenia (always)

Question 8

Special studies in HCL

Answer 8

Cytochemistry
-TRAP + (quick stain–> tartrate resistant acid phosphate. All red washes away except red on most cells except on hairy cells and a couple other)

Immunophenotype

• Positive for B-cell antigens
• Negative for CD5 (seen in CLL)

Question 9

Treatment and prognosis of HCL

Answer 9

Tx
-chemotherapy

Prognosis
-Good usually 10+ years

Question 10

Prolymphocytic leukemia things you must know

Answer 10

prolymphocytes

splenomegaly without lymphadenopathy

rare

aggressive

Question 11

Clinical and Lab findings in PL

Answer 11

Clinical

• splenomegaly without lymphadenopathy
• aggressive

Lab

• increased WBC
• decreased HgB
• decreased platelet count

Question 12

Large granulated lymphocyte leukemia things you must know

Answer 12

large granulated lymphocytes

T-cell***

Neutropenia

Long survival

Question 13

Clinical and Lab findings in LGL

Answer 13

modest leukocytosis

neutropenia

infections (from neutropenia)

long survival