CLL- Chronic Lymphocytic Leukemia Christie Asleson Hematology/Immunology

Overview Chronic lymphocytic leukemia (CLL) is cancer of the blood and bone marrow. The term "chronic" comes from that it progresses more slowly than other types  of leukemia. The term "lymphocytic" comes from the cells affected by the disease

Overview 15,000 ppl each year in the United States It is the most common type of leukemia in adults. Most of  those who get it are older than 55. Average age is 72 More common in men   In some people can remain slow-growing for years and never need treatment.      

How it develops Lymphocytes evolve from immature cells called hematopoietic stem cells. Healthy lymphocytes evolve through their life cycle eventually die. In CLL, changes in the diseased cells prevent them from maturing properly. They have a longer life span. Over time, accumulate in the bone marrow and in the tissues of the lymphatic system Interfering with other immune system functions.

Symptoms Many people with chronic lymphocytic leukemia have no symptoms. Those who do develop signs and symptoms may experience: Enlarged, but painless, lymph nodes Fatigue Fever Nigh sweats t  Weight loss  Frequent infection  Pain in the upper left portion of the abdomen, which may be caused by an enlarge spleen n

Risk Factors Inherited or genetics, traits and exposure to cancer-causing agents in the environment. Relatives such as a parent, child, or sibling, with CLL Most cases its associated with specific gene mutation

Diagnosis Many types of tests are performed Tests can reveal abnormatlities in cells Amount of blood cells Changes in bone marrow Other factors in deciding the course of treatment Common Tests Used: Cytogenetic studies, Immunohisto-chemistry studies,Flow cytometry, and  Molecular genetic studies

Diagnosis cont. In the Blood Blood Test Complete Blood Count Low numbers of RBC Platelet levels low Normal WBC levels diminished

Diagnosis cont. Bone Marrow Aspirates & Biopsies Physical Examination Bone Marrow biopsies- remove small peice of bone and marrow for examination Aspirate- Withdraw Small sample of liquid bone marrow Doctor will check: Lymph Nodes Spleen Liver First sign can be enlarged spleen or liver

Classification Classify or stage each patients CLL according to how far the disease has progressed Rai System Stage 0 Stage I Stage II Stage III Stage IV

Treatment No treatment yet that is considered a cure They are designed to slow progression of disease CLL develops very slowly

Treatment Cont. Radiation Therapy Used in rare cases Uses high-energy rays Destroys cancer cells Controls enlarged lymph nodes or spleen

Treatment Cont. Stem Cell Transplant For some patients Obtain stem cells by filtering from blood stream Then treated with high- dose of chemo. Doctors then transplant harvest stem cells

Treatment Cont. On going Care: People with CLL are likely to see their physician often to monitor the disease and to determine if it is progressing. These check-ups may include a physical exam, blood tests, bone marrow aspirates, biopsies, and radiographic studies.

Prognosis Out come depends on a few things Change in DNA? Lymphocytes spread throughout bone marrow? The Stage of CLL Treatment helping or not? General Health

Prognosis: What are the Survival Rates? 5 year Survival rate Treatment and responses to treatment vary greatly The five-year relative CLL survival rates by race and sex were: ~ 74.3% for Caucasian men  ~ 77.1% for Caucasian women  ~53.8% for African American men ~ 62.2 %for African American women.  

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