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Disease Acute leukemia Chronic leukemia Non-Hodgkin’s lymphoma Myeloma

Disease Acute leukemia Chronic leukemia Non-Hodgkin’s lymphoma Myeloma. Usual phenotype Precursor Differentiated. Chronic Lymphocytic Leukemia. Most common leukemia Usually age > 50 yrs Progressive accumulation of neoplastic, immunologically incompetent, clonal lymphocytes

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Disease Acute leukemia Chronic leukemia Non-Hodgkin’s lymphoma Myeloma

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  1. Disease Acute leukemia Chronic leukemia Non-Hodgkin’s lymphoma Myeloma Usual phenotype Precursor Differentiated

  2. Chronic Lymphocytic Leukemia • Most common leukemia • Usually age > 50 yrs • Progressive accumulation of neoplastic, immunologically incompetent, clonal lymphocytes • B cell origin > 98% • T cell 1-2%

  3. Clinical Features of CLL • Highly variable presentation • Asymptomatic, or vague, non-specific complaints • Recurrent infection 10% (often pneumococcus) • Signs • Lymphadenopathy (60%) • Splenomegaly (50%) • Hepatomegaly (< 40%)

  4. Clinical Features of CLL • Laboratory • blood and marrow lymphocytosis • B cell monoclonality: k vs l surface light chain single Ig gene rearrangement • hypoimmunoglobulinemia • Prognosis • Mean survival = 50-60 months • Range = few months to > 20 yrs

  5. Immunological Abnormalities in CLL • Disturbed Ab production • Hypogammaglobulinemia (50%)  bacterial infection • Decrease in one or more Ig fraction (80%) • Monoclonal paraprotein in serum (10%) • Autoantibodies (10%) • Minor impairments in cell-mediated immunity • Neoplastic lymphocytes • Monoclonal surface Ig • Abnormal response to Ig challenge

  6. Complications of CLL

  7. Rai Staging System for CLL

  8. Treatment of CLL • No evidence that therapy prolongs survival • Asymptomatic: watch and wait • Symptomatic: • Radiation for local complications • Chemotherapy: fludarabine, alkylators, combinations • Monoclonal antibodies (eg, Campath) • Stem cell transplantation

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