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IHO Week 4 > CLL Cases > Flashcards

CLL Cases Flashcards

1
Q

most common leukemia in adults

A

Chronic lymphocytic leukemia

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2
Q

tx CLL

A

allogenic stem cell transplant only curative therapy

Decision to treat based on age, performance status, symptoms, disease stage

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3
Q

Pathophysiology CLL

A

an uncontrolled clonal accumulation of mature lymphocytes.
Unclear mechanisms of initiation
Molecular characterization of CLL correlates with clinical outcomes
Mutated Ig VH genes
Unmutated Ig VH genes

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4
Q

Flow cytometry CLL

A

CD5+CD19+CD20+CD23+

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5
Q

Mantle cell lymphoma flow cytometry

A

CD5+CD23- cyclinD1+

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6
Q

CLL is the same as

A

SLL

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7
Q

Sxs CLL

A

Often indolent.
Progressive adenopathy –> fatigue, malaise, weight loss, fevers
Progressive BM involvement –> severe cytopenias, infections
AI sequelae and Richter’s transformation

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8
Q

Autoimmune complications of CLL

A

AIHA
Pure red cell aplasia
Immune-mediated thrombocytopenia
Neutropenia

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9
Q

Rai staging

A

Rai 0: lymphocytosis
Rai 1: lymphadenopathy
Rai 2: splenomegaly
Rai 3: HgB

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10
Q

Binet staging

A

A: lymphocytosis +/- 1-3 sites lymphadenopathy
B: lymphocytosis with > 3 sites lymphadenopathy
C: lymphocytosis + anemia and/or thrombocytosis

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11
Q

Poor prognostic factors CLL

A 
Advanced stage at diagnosis
Rapid lymphocyte doubling time
Diffuse marrow infiltration
Advanced age/male gender
CLL-PLL (secondary PLL)
Abnormal karyotype
Elevated b2-microglobulin, soluble CD23
CD38+ or ZAP-70+
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12
Q

CLL cytogenetic abnormalities

A 
13q-
Normal karyotype
Trisomy 12
11q-
17p- (nasty)
ALWAYS get FISH studies with CLL
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13
Q

CD38 and CLL

A

surrogate marker for Ig gene mutations
CD38+ = unmutated Ig genes = poorer prognosis
CD38-= mutated Ig genes = better prognosis (>20 yrs median survival)

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14
Q

ZAP-70 expression in CLL

A

Correlates with Ig VH gene mutations
Correlates CD38+ expression
ZAP-70+ = Poorer prognosis

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15
Q

CLL: when to treat

A 
Constitutional symptoms
Progressive lymphocytosis
Progressive lymphadenopathy
Progressive splenomegaly
Progressive bone marrow failure
Autoimmune complications
Richter’s transformation or secondary PLL
Your patient is uncomfortable with observation
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16
Q

tx options for CLL

A 
Corticosteroids
alkylating agents
Ibrutinib (BTK-inhibitor)
Venetoclax (bcl-2 inhibitor)
Nucleoside analogs
Monoclonal antibodies
Combination chemo
ASCT (stem cell transplant)
17
Q

only curative tx for CLL

A

allogenic transplant

IHO Week 4 (15 decks)

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