Flashcards in Chronic Lymphocytic Leukaemia Deck (50)
What is chronic lymphocytic leukaemia?
A monoclonal expansion of B-lymphocytes with accumulation of abnormal lymphocytes
Where do abnormal lymphocytes accumulate in chronic lymphocytic leukaemia?
- Bone marrow
- Lymph nodes
How do the lymphocytes in CLL appear morphologically?
What is abnormal about the lymphocytes in CLL?
They are immature and non-reactive
What is the result of the lymphocytes being immature and non-reactive in CLL?
Results in immunological compromise
How common is CLL compared to other leukaemias?
It represents about 1/4 of all leukaemias seen in clinical practice
When does CLL present?
It is largely a disease of older people
What causes CLL?
What are the known risk factors for CLL?
- Radiation exposure
Are people in the UK exposed to radiation levels high enough to increase the risk of CLL?
No, it occurs after nuclear accidents etc
Describe the presentation of CLL?
Variable, with insidious onset
Are most people symptomatic at presentation of CLL?
How are people diagnosed with CLL asymptomatically?
Following routine blood tests
What are the symptoms of CLL?
- Susceptibility to infection
- Symmetrically enlarged lymph nodes
- Abdominal discomfort from an enlarged spleen
- Bleeding or petechiae in skin or mucous membranes
What are the signs of CLL?
- Localised or generalised lymphadenopathy
- Skin infiltration
- Tonsillar enlargement
What are the differential diagnoses for CLL?
- Other forms of leukaemia
- Myelodysplasia and myeloproliferative diseases
What investigations should be done in CLL?
- Blood tests
- Lymph node biopsy
- Other tests
What blood tests should be done in CLL?
- Peripheral blood smear
- Direct anti-globulin test
- Bone marrow aspirate
What is found on FBC in CLL?
- Minimal clonal B cell lymphocytosis
- Normochromic, normocytic anaemia in advanced diseaes
What is found on peripheral blood smear in CLL?
Lymphocytosis, often with smudge cells
Why is a direct anti globulin test required in CLL?
Required before treatment to identify autoimmune-related haemolytic anaemias
What is found on bone marrow aspirate in CLL?
Lymphocytic replacement of normal marrow elements
When is a lymph node biopsy required in CLL?
If lymph nodes enlarge rapidly
Why is a lymph node biopsy required in CLL if lymph nodes enlarge rapidly?
To assess the possibility of transformation to a high-grade lymphoma
What is Richter's syndrome?
The transformation of CLL into a high grade-lymphoma with enlarged lymph nodes, fever, weight loss, and pain
What other tests may be done in CLL?
- Measurement of immunoglobulin levels if repeated infection
- Testing for TP53 gene deletion before treatment
- Status of relevant infections
What infections should you check for in CLL?
- Hep B and C
When should you check for hep B and C and cytomegalovirus in CLL?
Before chemo-immunotherapy or stem cell transplantation
What staging system is used for CLL in Europe?