CLL- Chronic Lymphocytic Leukemia

1. CLL- Chronic Lymphocytic Leukemia Christie Asleson Hematology/Immunology

2. Overview • Chronic lymphocytic leukemia (CLL) is cancer of the blood and bone marrow. • The term "chronic" comes from that it progresses more slowly than other types of leukemia. The term "lymphocytic" comes from the cells affected by the disease

3. Overview • 15,000 ppl each year in the United States • It is the most common type of leukemia in adults. • Most of  those who get it are older than 55. • Average age is 72 • More common in men  • In some people can remain slow-growing for years and never need treatment.    

4. How it develops • Lymphocytes evolve from immature cells called hematopoietic stem cells. • Healthy lymphocytes evolve through their life cycle eventually die. • In CLL, changes in the diseased cells prevent them from maturing properly. • They have a longer life span. • Over time, accumulate in the bone marrow and in the tissues of the lymphatic system • Interfering with other immune system functions.

5. Symptoms • Many people with chronic lymphocytic leukemia have no symptoms. Those who do develop signs and symptoms may experience: • Enlarged, but painless, lymph nodes • Fatigue • Fever • Nigh sweatst • Weight loss • Frequent infection Pain in the upper left portion of the abdomen, which may be caused by an enlarge spleenn

6. Risk Factors • Inherited or genetics, traits and exposure to cancer-causing agents in the environment. • Relatives such as a parent, child, or sibling, with CLL • Most cases its associated with specific gene mutation

7. Diagnosis • Many types of tests are performed • Tests can reveal abnormatlities in cells • Amount of blood cells • Changes in bone marrow • Other factors in deciding the course of treatment • Common Tests Used: • Cytogenetic studies, Immunohisto-chemistry studies,Flow cytometry, and  Molecular genetic studies

8. Diagnosis cont. In the Blood Blood Test • Complete Blood Count • Low numbers of RBC • Platelet levels low • Normal WBC levels diminished

9. Diagnosis cont. Bone Marrow Aspirates & Biopsies Physical Examination • Doctor will check: • Lymph Nodes • Spleen • Liver • First sign can be enlarged spleen or liver • Bone Marrow biopsies- remove small peice of bone and marrow for examination • Aspirate- Withdraw Small sample of liquid bone marrow

10. Classification • Classify or stage each patients CLL according to how far the disease has progressed • Rai System • Stage 0 • Stage I • Stage II • Stage III • Stage IV

11. Treatment • No treatment yet that is considered a cure • They are designed to slow progression of disease • CLL develops very slowly

12. Treatment Cont. • Radiation Therapy • Used in rare cases • Uses high-energy rays • Destroys cancer cells • Controls enlarged lymph nodes or spleen

13. Treatment Cont. • Stem Cell Transplant • For some patients • Obtain stem cells by filtering from blood stream • Then treated with high-dose of chemo. • Doctors then transplant harvest stem cells

14. Treatment Cont. • On going Care: • People with CLL are likely to see their physician often to monitor the disease and to determine if it is progressing. •  These check-ups may include a physical exam, blood tests, bone marrow aspirates, biopsies, and radiographic studies.

15. Prognosis • Out come depends on a few things • Change in DNA? • Lymphocytes spread throughout bone marrow? • The Stage of CLL • Treatment helping or not? • General Health

16. Prognosis: What are the Survival Rates? • 5 year Survival rate • Treatment and responses to treatment vary greatly • The five-year relative CLL survival rates by race and sex were: • ~ 74.3% for Caucasian men  • ~ 77.1% for Caucasian women •  ~53.8% for African American men • ~ 62.2 %for African American women.

17. The End