{"id":5339,"date":"2021-05-15T23:53:42","date_gmt":"2021-05-15T21:53:42","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/hematology\/hematological-oncology\/chronic-lymphocytic-leukemia-lymphoma-cll\/"},"modified":"2022-02-07T00:09:13","modified_gmt":"2022-02-06T22:09:13","slug":"chronic-lymphocytic-leukemia-lymphoma-cll","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/chronic-leukemias\/chronic-lymphocytic-leukemia-lymphoma-cll\/","title":{"rendered":"Chronic lymphocytic leukemia (CLL)"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><div class=\"intro\">Chronic lymphocytic leukemia is a clonic proliferation of mature B-cells.<\/div><\/p>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" id=\"background\" class=\"wp-block-heading\" id=\"background\" class=\"title_collection title1\">Background<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">In chronic leukemias, we see an accumulation of mature,&nbsp;<strong>mutated myeloid cells<\/strong>. The cells will undergo&nbsp;uncontrolled proliferation due to<strong>&nbsp;hyperactivated tyrosine kinases<\/strong>&nbsp;or other signaling pathway alterations.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Chronic leukemias have a slow progression, and they can progress into acute leukemias (but not the other way around!)<\/li><li>Incutable<\/li><li>Mostly affect older patients.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h3 class=\"wp-block-heading\" id=\"chronic-lymphocytic-leukemia\" class=\"wp-block-heading\" id=\"chronic-lymphocytic-leukemia\" class=\"title_collection title1\">Chronic lymphocytic leukemia<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Chronic<\/strong> = slow onset, of mature cells; <strong>lymphocytic<\/strong> = of lymphoid lineage (specifically, <strong>B-cells<\/strong>); <strong>leukemia<\/strong> = cancer of the blood and bone marrow.<\/li><li><strong>CD5+ B-cells<\/strong> undergo malignant transformation and begin to proliferate, accumulating further genetic mutations.<\/li><li>The malignant B-cells spread from the bone marrow to the blood, spleen, and lymph nodes.<ul><li>It is sometimes considered as <\/li><\/ul><\/li><li>CLL is the most common type of leukemia in the Western world, typically affecting older adults.<\/li><li>It can progress into B-cell prolymphocytic leukemia and DLBCL.<\/li><li>CLL and SLL (small lymphocytic lymphoma) are identical, except in CLL the malignant cells are found mostly in the blood and bone marrow; therefore, they are often grouped together as CLL\/SLL under non-Hodgkin lymphomas.<\/li><li><strong>Monoclonal B-cell lymphocytosis<\/strong> is the appearance of monoclonal B-cells in the peripheral blood. It is rare, typically appearing in older patients, and is distinguished from CLL by normal B-cell counts (&lt;5G\/L) and no lymphatic tissue involvement.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" id=\"etiology\" class=\"wp-block-heading\" id=\"etiology\" class=\"title_collection title2\">Etiology<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">The etiology is unknown, but there is evidence for genetic predisposition.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" id=\"clinical-presentation\" class=\"wp-block-heading\" id=\"clinical-presentation\" class=\"title_collection title2\">Clinical presentation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Anemia and hemorrhages<\/li><li>Increased susceptibility to infections (initially to bacteria, later to viruses, especially HZ; due to hypogammaglobulinemia)<\/li><li>Non-tender lymphadenopathy<\/li><li>Splenomegaly<\/li><li>B-signs (fever, night sweats, and weight loss)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<ul class=\"wp-block-list\"><li>Blood count (increase in B-cell count, &gt;5G\/L; anemia and thrombocytopenia, typically of autoimmune origin)<\/li><li>Blood smear (small lymphocytes with smudge or <em>Gumprecht&nbsp;shadow<\/em> cells)<\/li><li>Immunohistochemistry (CD19, CD5, and CD23+ with low levels of surface Ig and a single light chain)<\/li><li>Flow cytometry (CD38, ZAP70)<\/li><li>Bone marrow sample (demonstrating massive lymphocytic proliferation)<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" id=\"staging\" class=\"wp-block-heading\" id=\"staging\" class=\"title_collection title2\">Staging<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<p class=\"wp-block-paragraph\">The <strong>Rai <\/strong>(4 stages) and <strong>Binet<\/strong> (3 stages) systems are used for prognostic and predictive reasons, classified into stage 0-IV.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_7\">\n<h4 class=\"wp-block-heading\" id=\"somatic-hypermutation-of-the-immunoglobulin-heavy-chain-genes-ighv\" class=\"wp-block-heading\" id=\"somatic-hypermutation-of-the-immunoglobulin-heavy-chain-genes-ighv\" class=\"title_collection title2\">Somatic hypermutation of the immunoglobulin heavy chain genes (IgHV)<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_7\">\n\n\n<p class=\"wp-block-paragraph\">IgHV (immunoglobulin heavy chain variable) mutations are said to be equivalent to somatic hypermutation, serving as a <strong>positive prognostic factor<\/strong> (increase patient survival).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">They are considered mutated If the difference of the IgHV gene sequence is &gt;2% from the germline sequence.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_8\">\n<h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_8\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Ibrutinib<\/strong> (BTKi)<\/li><li><strong>Venotoclax <\/strong>(BCL-2i) + <strong>obinutuzumab <\/strong>(anti-CD20)<\/li><li><strong>FCR<\/strong>: <strong>fludarabine <\/strong>(purine analog) + <strong>cyclophosphamide <\/strong>(alkylating agent) + <strong>rituximab <\/strong>(anti-CD20)<\/li><li><strong>BR<\/strong>: <strong>bendamustine <\/strong>(alkylating agnet) + <strong>rituximab<\/strong><\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" id=\"background\" class=\"wp-block-heading\" id=\"background\">Background<\/h3><h3 class=\"wp-block-heading\" id=\"chronic-lymphocytic-leukemia\" class=\"wp-block-heading\" id=\"chronic-lymphocytic-leukemia\">Chronic lymphocytic leukemia<\/h3><h4 class=\"wp-block-heading\" id=\"etiology\" class=\"wp-block-heading\" id=\"etiology\">Etiology<\/h4><h4 class=\"wp-block-heading\" id=\"clinical-presentation\" class=\"wp-block-heading\" id=\"clinical-presentation\">Clinical presentation<\/h4><h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" id=\"staging\" class=\"wp-block-heading\" id=\"staging\">Staging<\/h4><h4 class=\"wp-block-heading\" id=\"somatic-hypermutation-of-the-immunoglobulin-heavy-chain-genes-ighv\" class=\"wp-block-heading\" id=\"somatic-hypermutation-of-the-immunoglobulin-heavy-chain-genes-ighv\">Somatic hypermutation of the immunoglobulin heavy chain genes (IgHV)<\/h4><h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Background In chronic leukemias, we see an accumulation of mature,&nbsp;mutated myeloid cells. The cells will undergo&nbsp;uncontrolled proliferation due to&nbsp;hyperactivated tyrosine kinases&nbsp;or other signaling pathway alterations. Chronic leukemias have a slow progression, and they can progress into acute leukemias (but not the other way around!) Incutable Mostly affect older patients. Chronic lymphocytic leukemia Chronic = slow [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":5474,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5339","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Chronic lymphocytic leukemia (CLL) &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/chronic-leukemias\/chronic-lymphocytic-leukemia-lymphoma-cll\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/chronic-leukemias\\\/chronic-lymphocytic-leukemia-lymphoma-cll\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/chronic-leukemias\\\/chronic-lymphocytic-leukemia-lymphoma-cll\\\/\",\"name\":\"Chronic lymphocytic leukemia (CLL) &#8211; 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