shared:heme:cll
Table of Contents
Chronic Lymphocytic Leukemia
Workup
- Physical Exam
- Baseline labs
- Imaging: CT > PET
- Repeat peripheral flow
- Bone marrow biopsy
- HBV, HCV (less important now that rituxamab falling out of favor)
Staging
- Biret
- A: <3 lymphoid
- B: >3 lymphoid
- C: Hgb < 10 or platelets < 100
- Rai
- 0: lymphocytosis
- I: lymphadenopathy
- II: hepatosplenomegaly
- III: Hgb < 11
- IV: platelets < 100
Diagnosis
- B cells > 5 x 10^9
- lymphadenopathy or splenomegaly
- cytopenia
- CLL-related symptoms
- if meets bottom three criteria, then small lymphocytic lymphoma
Treatment
- first-line
- ibutrinib (BTK inhibitor)
- adverse effects: diarrhea, rash, bleeding, atrial fibrillation
- venetoclax (now 1st line)
- refractory:
- idelalisib
- immunotherapy
- allo-SCT
- CAR-T
- lenalidomide
- checkpoint inhibitors
Indications
- Bone marrow failure: Hgb < 11, platelets < 100
- Symptoms
- weight loss >10% over 6 months
- ECOG ≥ 2
- T ≥ 38°C for 2 weeks
- night sweats
- Splenomegaly (>6 cm or symptomatic)
- Lymphadenopathy (>10 cm or symptomatic)
- Progression of disease
- ALC increase >50% in 2 months
- ALC doubling time <6 months
Complications
- infection
- autoimmune (5-10%)
- AIHA
- ITP
- pure red cell aplasia
- malignancy
- DLBCL
- Skin: 5-10x risk SCC/BCC
Poor prognostic factors
- 17p13 deletion
- 11q22.3
- Trisomy 12
- 13q14
- NOTCH, SF3D1?
- hypermutation?
- beta-2 macroglobulin
shared/heme/cll.txt · Last modified: 2020/02/11 17:53 by 127.0.0.1