Chronic Lymphocytic Leukemia - The Leukemia & Lymphoma Society

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Other factors may be signs of faster-growing disease (higher-risk CLL) and indicate the need for closer follow-up with the doctor. For example: Blood lymphocyte People with CLL whose lymphocyte number doubles in doubling one year have higher-risk CLL and need closer followup; a lymphocyte number that remains stable indicates a relatively lower risk. CD38 CD is an abbreviation for “cluster designation,” a term used with a number to identify a specific molecule on the surface of an immune cell. The expression of CD38 on CLL cells may be an indicator of higher-risk CLL. B2M A higher level of serum beta 2-microglobulin, (B2M) a protein that is shed from CLL cells, is associated with a greater extent of disease. Several studies have found that B2M and other serum markers, such as CD23, may help predict survival or progression-free survival. Tests for these markers need to be standardized, and further study in clinical trials is needed to evaluate their relative value in managing the treatments of people with CLL. Unmutated IgHv The unmutated immunoglobulin heavy chain variable region gene (IgHv) suggests the likelihood of higher-risk disease. Forty percent of CLL patients at diagnosis will have this whereas 60 percent will have the more favorable IgHv mutated disease. ZAP-70 ZAP-70 (zeta-associated protein 70), when increased, may be associated with higher-risk disease. It should be noted that further study in clinical trials is needed to standardize the assessment of ZAP-70. The National Comprehensive Cancer Network (NCCN) guidelines state that the evaluation of ZAP-70 expression by flow cytometry can be challenging and is not recommended outside of a clinical trial. page 12 I 800.955.4572 I www.LLS.org
Treatment Current therapies do not offer patients a cure for CLL, but there are treatments that help manage the disease. Treatments for CLL include { { Watch and wait { { Single or combination drug therapy { { White cell (neutrophil) growth factors { { Radiation therapy (rarely used) { { Splenectomy (rarely used) { { Treatment in a clinical trial (see page 20). { { Drug therapy with new drugs or new drug combinations { { High-dose chemotherapy and allogeneic stem cell transplantation. The goals of CLL treatments are to { { Slow the growth of the CLL cells { { Provide long periods of remission (when there are no signs of CLL and/or people feel well enough to go about their day-to-day activities) { { Improve survival { { Help people to feel better if they have infections, fatigue or other symptoms. Some people with CLL can be managed with a watch and wait approach for years before the disease progresses. The decision to treat a person with CLL is based on a number of factors (see Table 2). Table 2. Some Factors That Influence the Decision to Treat Patients Who Have CLL* Enlarging lymph nodes Enlarging spleen Worsening anemia Absolute lymphocyte count (>300)** Falling platelet count CLL symptoms (such as fatigue, night sweats, weight loss, fever, etc.) * Several of these factors are often present at the same time. ** Rapidly rising lymphocyte count in asymptomatic patients may not be an independent factor to begin treatment. Chronic Lymphocytic Leukemia I page 13
Page 1 and 2: Chronic Lymphocytic Leukemia JUNE D
Page 3 and 4: Table of Contents 2 Introduction 2
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Page 9 and 10: etween herbicides used in Vietnam a
Page 11 and 12: infrequently, cause an increase in
Page 13: Chromosomal Changes. Certain chromo
Page 17 and 18: Chemotherapy. Chlorambucil (Leukera
Page 19 and 20: Table 3. Some Drugs Used to Treat C
Page 21 and 22: Prolymphocytes. About 15 percent of
Page 23 and 24: Kinase Inhibitor Therapy. Kinases a
Page 25 and 26: The National Cancer Institute-spons
Page 27 and 28: Table 5. CLL and Related Diseases L
Page 29 and 30: { { The neutrophils and monocytes a
Page 31 and 32: Medical Terms Allogeneic Stem Cell
Page 33 and 34: Bone Marrow Biopsy. A test to exami
Page 35 and 36: e counted. One use of flow cytometr
Page 37 and 38: HLA. The abbreviation for “human
Page 39 and 40: egg or the sperm and can be transmi
Page 41 and 42: Promyelocyte. A cell that is formed
Page 43 and 44: More Information Free LLS publicati
Page 45 and 46: Notes Chronic Lymphocytic Leukemia
Page 47 and 48: REACH OUT TO OUR INFORMATION SPECIA

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