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Flashcards in CML and CLL Deck (12)
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1

CML is

chronic clonal proliferation of myeloid cells (basophils, neutrophils, neutrophils) = myeloproliferative disorder
Philadelphia chromosome in 80% cases

2

Presentation of CML and progression

Chronic and insidious
Systemic symptoms = weight loss, tiredeness, fevers, sweats
Gout features due to purine breakdown
abdominal discomfort and fullness
infection
thrombotic episodes

Progression:
fever and infection
bone and joint pain
haemorrhage and thrombosis

3

examination for CML

Splenomegaly
Hepatomegaly
Anaemia
Bruising

4

Ix for CML

FBC = WBC high, normochromic anaemia, low neut alk phos (NAP)
Bone Marrow Aspirate = hypercellular
Cytogenetic analysis = Philadelphia chromosome

5

Management of CML

Chemotherapy : imatinib
Stem cell transplant: allogenic bone marrow is curitive and used in young patients or those intolerant to imatinib

6

CLL is?

Accumulation of mature B cells that have escaped apoptosis and undergone cell-cycle arrest. Commonest Leukaemia

7

Staging for CLL

Rai Staging
0 = lymphocytosis alone
I = lymphocytosis + lymphadenopathy
II = lymphocytosis + splen or hepatomegaly
III = lymphocytosis + anaemia (Hb < 110)
IV = lymphocytosis + platelets < 100

8

History of CLL

Often nothing - incidental findings on blood
= recurrent infections
= anaemia
= painless lymphadenopathy
= LUQ discomfort splenomegaly

9

Examination of CLL

fever
anaemia
enlarged, tender, rubber nodes
splenomegaly + hepatomegaly

10

Ix

FBC
- High lymphocytes > 5
- later, decreased Hb, neutrophils and platelets secondary to bone marrow infiltration
Blood Film
- Normal appearing lymphocytes
- no immature blast cells
Bone marrow
- heavily infiltrated with lymphocytes
Direct Coomb's test
- may be +ve if haemolytic anaemia

11

when to and what to manage in CLL

0 = watch and wait
I - II = treat if progression
III - IV = treatment indicated

Absolute indication:
- marrow failure
- recurrent infection
- systemic symptoms
- massive splenomegaly or lymphadenopathy
- haemolysis

Supportive Tx
- Steroids, transfusion, IvIg, Prophylactic Abx, allopurinol for hyperuricaemia

Specific Tx
- FCR (chemo)
- Allogenic stem cell transplant

12

Complications of CLL

AI haemolysis
Infections due to low IgG
Marrow Failure