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Chronic Lymphocytic Leukemia PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Chronic Lymphocytic Leukemia”.

This medical PowerPoint presentation is about chronic lymphocytic leukemia (CLL), a type of cancer that affects the blood and bone marrow, causing an overproduction of abnormal white blood cells called lymphocytes. These lymphocytes are unable to fight off infections and can accumulate in the body, leading to enlarged lymph nodes, spleen, and liver.

Tags : Chronic Lymphocytic Leukemia, cancer, blood, bone marrow, Hematology, Hematology PowerPoint presentation

Published on : May 29, 2023 | Views : 1344 | Downloads : 3

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Slide 1-

Chronic Lymphocytic Leukemia
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Definition Clonal B cell malignancy. Progressive accumulation of long lived mature lymphocytes. Increase in anti-apoptotic protein bcl-2. Intermediate stage between pre-B and mature B-cell.
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Cancer statastics 2000; CA J Clin 2000; 50:7-33 Epidemiology Most common leukemia of Western world. Less frequent in Asia and Latin America. Male to female ratio is 2:1. Median age at diagnosis is 65-70 years. In US population incidence is similar in different races.
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Etiology & Risk factors High familial risk with two-fold to seven-fold higher risk. No documented association with environmental factors. No established viral etiology.
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Blood 1996; 87: 4990 Diagnostic Criteria Defined by NCI & IWCLL. Persistent lymphocytosis. Absolute count more than 5000. Mature appearing B-cells with <10% of prolymhocytes
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Flow Cytometry CD 19 and/or CD 20 are always co expressed with CD 5. Weak expression of surface immunoglobulins (sIgM & sIgD). CD 21, CD 23, CD 24 may be expressed.
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Bone Marrow Not required for diagnosis. Recommended to estimate the extent for prognostic implications. Diffuse infiltration has poor prognosis.
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J Mol Med 1999; 77:266 Cytogenetics Deletions in chromosome 13 at q 14 Chromosome 11 at q22 or q23. Trisomy-12. Less common are deletions in chromosome 17 & 6.
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Clinical Features Disease of elderly with wide spectrum of clinical features. 20% are asymptomatic. Classic B symptoms. Variable physical findings with normal to diffuse LAD , hepato/splenomegaly.
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Other Labs Hypogammaglobulinemia seen >50%. 5-10% have small monoclonal peak. Positive Coombs’ test in 30% . Autoimmune hemolytic anemia & thrombocytopenia in <10%
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The Rai Staging System Stage 0 Lymphocytosis only (> 15,000/mm3) Stage 1 Lymphocytosis and lymphadenopathy Stage 2 Lymphocytosis and splenomegaly with or without lymphadenopathy Stage 3 Lymphocytosis and anemia (Hgb <11 g/dL) with or without lymphadenopathy or hepatosplenomegaly Stage 4 Lymphocytosis and thrombocytopenia (Plt < 100,000/UL) with or without anemia, lymphadenopathy or hepatosplenomegaly
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Modified Rai Staging g. Low-risk: stage 0, MS > 13 years. Intermediate-risk: stage I & II with MS about 8 years. High-risk: stages III & IV with MS about 3 years
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The Binet Staging System Stage A No anemia, no thrombocytopenia, <3 involved nodal areas Stage B No anemia, no thrombocytopenia, >=3 involved nodal areas Stage C Anemia (Hgb < 10 g/dL) and/or thrombocytopenia (Plt < 100,000/uL)
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Blood 94: 1848-1854, 1999 Other Prognostic Features Bone marrow pattern of lymphoid infiltration. Lymphocyte doubling time. Serum beta-2-microglobulin. Mutational status of Ig V and CD 38 expression have recently been identified.
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Blood 1996; 88 (suppl 1): 141a Treatment Nucleoside analogs like Fludarabine is the drug of choice. More effective in higher CR & longer PFS compared to alkyalating agents. No survival advantage. Fludarabine in various combinations with Cytoxan & Rituxan are widely used.
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Blood 1999; 94 (suppl 1); 705a Monoclonal antibodies Campath (anti-CD 52) is recently approved for refractory CLL. Results in profound lympocytopenia, both B and T cells are destroyed. Rituxan (anti CD 20) is widely used both as single agent and in combination.
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J Clin Oncol 16:2817-2724 Bone marrow transplantation Allogenic BMT is a viable option in younger patients. Durable response rates seen in advanced, refractory disease. Autologous BMT using purged marrow have been investigated in elderly.
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Transformation Large- cell lymphoma/ Richter’s Aggressive presentation Extranodal involment Sharp rise in LDH CHOP is standard treatment. Prolymphoctic leukemia. > 55% increase in prolymphocytes Progression of splenomegaly & cytopenias Refractoriness to treatment.