B-cell chronic lymphocytic leukemia

B-cell chronic lymphocytic leukemia - Chronic
Rahul Soman, M. Pharm

 

Definition  

Proliferation and progressive accumulation of morphologically mature but immunologically less mature monoclonal B-cells in the blood, bone marrow, and lymphoid tissues

 

Medical History  

* White

* Male

* Middle-aged or Older

* Family history of Lymphoid leukemia

* Russian or Eastern European Jew

 

Findings  

* Asymptomatic

* Lymphadenopathy

* Hepatosplenomegaly

* Asthenia

* Fatigue

* Fever

* Night sweats

* Weight loss

* Increased susceptibility to infections

* Blood coagulation disorder

* Insect bite reaction

* Easy bruising

 

Tests  

 

Suspected chronic lymphocytic leukemia  

* Complete blood count with white cell differential, manual: Lymphocyte count ranges from 5 to 500 x 109/L in CLL; neutrophil proportion, hemoglobin, and platelets are decreased .

 

Initial evaluation of suspected chronic lymphocytic leukemia  

* Lymphocyte count by cell surface antigen phenotype

 

Initial evaluation of suspected chronic lymphocytic leukemia  

* Lymphocyte surface immunoglobulin identification

 

Suspected and known chronic lymphocytic leukemia  

* Bone marrow examination: Bone marrow lymphocyte count may range from 30% up to 99% of all nucleated cells; a diffuse pattern of lymphocytic infiltration has a poor prognosis .

 

Initial evaluation of suspected and known chronic lymphocytic leukemia  

* Serum protein electrophoresis

* Immunoglobulin measurement

* Coombs test - anti-human globulin

 

Initial evaluation of chronic lymphocytic leukemia and treatment planning  

* Hepatic function panel

* Biochemical evaluation of blood urea/renal function

* Electrolytes measurement, serum

 

Differential Diagnosis  

* Hairy cell leukemia

* Waldenström macroglobulinemia

* Prolymphocytic leukemia

* Large granular lymphocytic leukemia

* Mantle cell lymphoma

* Smoldering chronic lymphocytic leukemia

 

Treatment  

 

Procedural Therapy  

 

Chronic lymphocytic leukemia  

* Hemopoietic stem cell transplant: Stem cell transplantation increases disease-free survival and may increase overall survival in poor-risk CLL patients .