1. CLL- Chronic Lymphocytic Leukemia
Christie Asleson
Hematology/Immunology

2. 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

3. 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.      

4. 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.

5. 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

6. 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

7. 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

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

9. 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

10. 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

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

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

13. 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

14. 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.

15. 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

16. 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.

17. The End