Comprose most lymphomas.
B cell lymphomas account for 85% of NHL, while T cell lymphomas consist of about 15% of NHL.
Small Lymphocytic Lymphoma
The same disease as CLL. This just does not have the lymphocytosis.
If you look at the bone marrow, it is identical to CLL.
Chronic Lymphocytic Leukemia
A neoplastic disease characterized by the clonal proliferation and accumulation of small, mature-appearing immunologically incompetent B lymphocytes in the blood, marow, lymph nodes, and spleen. Don't make useful antibodies, but are small and non-sticky so they aren't overtly harmful either.
Accounts for 40% of all leukemias in patients older than 65. It is the most common lymphoid malignancy in the western world. Incidence increases with age... Median age of diagnosis is 72... CLL is statistically VERY unlikely in young patients.
Consistent with CLL
Smudge cells in the presence of lymphocytosis is highly suggestive of CLL.
Family History and CLL
Tightly linked. One of the most heritable blood cancers.
Does not indicate severity, however.
B Cell Ontogency
Immature B cells
Mature B cells
B Cell Ontology and B Cell Malignancies
Stem cell - ALL
Pre-B cell - cALL
Immature B cell - NHL
Mature B cell - CLL/HCL
Plasma cell - WM/MM
Diagnostic Test for CLL
Flow cytometry of the peripheral blood.
You want to look at the lymphocyte differential. You would expect to see skewed Kappa/Lambda ratio as well as elevated CD19+ count if it is CLL.
You need to have at least > 5 x 109 / L B lymphocytes in peripheral blood for > 3 months to be classified as CLL. If less, it is called "monoclonal B cell lymphocytosis", which may turn into CLL later.
Diagnostic Test for T Cell Lymphoma
They have the TCR, not the kappa/lambda chains
Threshold for CLL Diagnosis
Minimum needed to confirm diagnosis is > 5x109 /L B lymphocytes in the peripheral blood for more than 3 months.
Less than this is called "monoclonal B cell lymphocytosis", which may turn into CLL at a later date.
CLL Natural History
Elevated lymphocytes in peripheral blood and bone marrow. (0)
Lymphocytosis with enlarged nodes. (1)
Lymphocytosis with enlarged spleen/liver. (2)
Lymphocytosis with anemia. (3)
Lymphocytosis with thrombocytopenia. (4)
Indications for Treatment in CLL
Lymphocyte doubling time of less than 6 months
Symptomatic lymphadenopathy or splenomegaly
Significant anemia or thrombocytopenia
New Therapies for CLL
Monoclonal antibodies (rituximab, alemtuzumab)
Tyrosine kinase inhibitors
Watch and Waiting
Often used in CLL.
Early treatment does not improve survival. Oftentimes things are not serious.