Leukaemia (chronic lymphocytic)

Chronic lymphocytic leukemia (CLL) is a type of cancer that affects the blood and bone marrow. It primarily involves a type of white blood cell called lymphocytes, which are part of the immune system. CLL is characterized by the accumulation of abnormal lymphocytes in the blood, bone marrow, and lymphoid tissues.

Key Points about CLL

Pathophysiology:
- CLL is a clonal disorder, meaning it originates from a single cell that undergoes malignant transformation.
- The abnormal lymphocytes in CLL are usually B cells, although rare cases involve T cells.
- These leukemic cells accumulate because they do not die as they should, leading to overcrowding in the bone marrow and blood.
Symptoms:
- Many patients are asymptomatic at diagnosis and are found to have CLL through routine blood tests.
- Symptoms, when present, may include fatigue, night sweats, weight loss, frequent infections, and swollen lymph nodes.
Diagnosis:
- Diagnosis is often made based on blood tests showing elevated lymphocyte counts.
- Flow cytometry is used to identify the immunophenotype of the cells, which helps confirm the diagnosis.
- Bone marrow biopsy and imaging studies may be used for staging.
Staging and Prognosis:
- CLL is staged using the Rai or Binet staging systems, which consider factors such as lymphocyte count, hemoglobin level, and platelet count.
- Prognosis varies widely; some patients live for decades with little progression, while others have a more aggressive form of the disease.
Treatment:
- Early-stage CLL often does not require immediate treatment and is managed with a watch-and-wait approach.
- Treatment options for symptomatic or advanced-stage CLL include chemotherapy, targeted therapy (such as BTK inhibitors like ibrutinib), and monoclonal antibodies (such as rituximab).
- Stem cell transplantation may be considered in younger patients or those with high-risk disease.
Risk Factors:
- The exact cause of CLL is not known, but risk factors include age (most common in people over 60), family history of CLL, and certain genetic mutations.
Research and Advances:
- Ongoing research aims to better understand the genetic and molecular basis of CLL.
- New therapies and combination treatments are continuously being developed and tested in clinical trials.

Summary

Chronic lymphocytic leukemia is a slow-growing blood cancer that affects older adults. It is often diagnosed incidentally and can vary greatly in its clinical course. Advances in understanding the disease and developing targeted therapies have improved the prognosis for many patients. Management strategies range from active surveillance in early stages to various therapeutic options for more advanced or symptomatic cases.

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