Chronic Lymphocytic Leukemia CLL I

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					                      Chronic Lymphocytic Leukemia (CLL)

  I.   More common in older patients (90% are over 50 yrs. old)

 II.   CLL is a malignant monoclonal proliferation of immunoglobulin
       B-lymphocytes.

       A.   The life span of these abnormal lymphocytes is extremely
            long (unlike normal B lymphocytes)
       B.   The immunologic responses of these lymphs are often
            defective.

III.   Etiology

       A.   Ionizing radiation plays no part in the development of CLL.

       B.   Possible etiological factors include:

            1.    Genetics(most cases of familial leukemia are CLL)
            2.    Age     (possible due to decreased immunoglobulins in
                           old age)
            3. Male Predominance (There is a predominance of CLL in
                                    males in a ratio of 2:1)
       C.   There is evidence of a possible viral etiology. (HTLV-I)

 IV.   Clinical features:

       A.   Insidious Onset
       B.   Main Physical Findings:    Splenomegaly and Enlarged
                                       non-Tender Lymph nodes

  V.   Laboratory features:

       A.   WBC usually increased, Platelets usually normal but may be
            decreased.

       B.   80-90% of the cells are normal looking small to medium sized
            lymphocytes with narrow rims of cytoplasm.

       C.   The cells are more fragile than normal, and are often
            disrupted when making the slide, resulting in many
            smudge cells.
         D.    Occasional immature lymphocytes (prolymphocytes,
               lymphoblasts) may be present. In some cases the lymphs are
               larger with more abundant cytoplasm, or occasionally a mixed
               population of large and small lymphs may occur.

         E.    Approximately 10% of the patients with CLL develop an
               autoimmune hemolytic anemia (AIHA)

 VI.     Primary cause of death:    infection

         (Coexisting disease is another common cause of death since CLL
         is primarily a disease of the elderly)


 VII. Course and Management:

         Median survival is 5 years. It is not unusual for patients to
         live for 10-15 years with little or no treatment.

         The prognosis is better if there is no anemia or
         thrombocytopenia.


CHROLYML.DOC
Thursday, August 30, 2012

				
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