| ID | 153 |
|---|---|
| Name | CHRONIC LYMPHOCYTIC LEUKEMIA |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations: 1. Blood examination shows: Anemia, high W.B.C. count (1 lac/cmm or more), 80-90% of the cells are mature lymphocytes. Platelet count is initially normal but gradually comes down. 2. Bone-marrow cytology: Shows increased lymphocytes, reduced megakaryocytes & in presence of hemolytic anemia erythroid hyperplasia may develop. |
| Management | |
| Introduction | Chronic lymphocytic leukemia (CLL) is a clonal malignancy of B lymphocytes (rarely T lymphocytes). The disease is usually indolent, with slowly progressive but ever-increasing accumulation of long-lived small lymphocytes. These are immunoin competent cells, unable to do immune function and normal bone marrow hematopoiesis. This is the commonest variety of leukemia. It occurs more frequently in males (male:female ratio-2:1), the majority of patients are over the age of 45 with a peak at 65 |
| History | |
| Etiology | |
| Clinical Features | Clinical features: The onset is very insidious. Tiredness and vague ill health are common. Anemia develops lately. There are presence of firm, rubbery, discrete and painless lymphnodes in the cervical, axillary and inguinal region. Spleen is usually palpable. The liver may also be enlarged. There is susceptibility to secondary infection due to altered immunity. Staging of chronic lymphocytic leukemia (CLL): 1. Clinical stage A (60% patients) No anemia or thrombocytopenia; fewer than three areas of lymphoid enlargement. 2. Clinical stage B (30% patients) No anemia or thrombocytopenia; three or more areas of lymphoid enlargement. 3. Clinical stage C (10% patients) Anemia and/or thrombocytopenia, with regardless number of areas of lymphoid enlargement. |
| Preventions | |
| Treatment | Treatment: 1. General & supportive treatment: i. Adequate rest. ii. Nutritious diet, iii. Blood transfusion for sypmtomatic anemia & thrombocytopenia. iv. For infection appropriate antibiotic may be used but for prevention gamma globulin may be given. 2. Chemotherapy: Clinical stage A: No specific treatment is required for this group of patients unless progression occurs. Clinical stage B & Clinical stage C: Chlorambucil (an alkylating agent) oral chemotherapy will reduce the abnormal lymphocyte mass and produce symptomatic improvement in most patients. Very recently, the purine analogue fludarabine, in combination with cyclophosphamide (alkylating agent), has been found with increased remission rates and disease-free survival, although there is an increased risk of infection. Bone marrow failure or autoimmune cytopenias may respond to corticosteroid treatment. 3. Radiotherapy: May be useful for lymph nodes causing discomfort or local obstruction. 4. Splenectomy: May be required to improve low blood counts due to autoimmune destruction or hypersplenism. |
| Complications | |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
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