Chronic Lymphocytic Leukemia - The Leukemia & Lymphoma Society

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Follow-Up Care. People with CLL need regular medical follow-up after they have completed treatment. It is important to assess the full effect of therapy as well as to identify any return of progressive disease that may require additional therapy. Minimal Residual Disease. Some people with CLL have such a low level of remaining CLL cells after treatment that these cells cannot be detected by the usual clinical tests, such as blood and marrow examinations. The term used for this condition is “minimal residual disease” (MRD). More sensitive tests may be performed to detect the presence of abnormal cells. The methods generally used to detect MRD in people with CLL are four-color cell flow cytometry and polymerase chain reaction (PCR). The benefit of flow cytometry is its widespread reproducible use that now is standard as part of clinical trials. These techniques may provide information that can help the doctor to recognize a disease relapse and to start treatment again. However, treating asymptomatic patients with MRD remains a research question and should not be pursued outside of clinical trials. People who have been treated for CLL and/or other cancers are encouraged to keep a record of the treatments they have received. It is a good idea to share these records with the doctors who monitor general health problems, both during treatment and after treatment ends. Regular screening and monitoring for skin, colorectal, breast and other types of cancer is advisable. Related Diseases The diseases mentioned in this section result from the cancerous transformation of a type of lymphocyte; the accumulation of these cancer cells occurs mainly in the marrow, the blood and the spleen (see Table 5 on page 25). There are distinguishing characteristics that enable the hematology oncologist to identify each disease, including the appearance and the immunophenotype of the cancer cells; the cells’ varying effects on normal marrow and blood cell development; and the cells’ varying effects on other parts of the body, such as the kidneys, bowels and nervous system. The diseases represent a range of clinical severity. At one end of the range, there are the diseases that may be stable and may not advance in severity for some months or years, or occasionally indefinitely. At the other end of the range, there are diseases associated with difficulties that may be present at diagnosis and possibly get worse, requiring immediate treatment and frequent observation. page 24 I 800.955.4572 I www.LLS.org
Table 5. CLL and Related Diseases Less rapidly progressive Chronic lymphocytic leukemia Hairy cell leukemia* Large granular lymphocytic leukemia Small cell lymphocytic lymphoma** Waldenström macroglobulinemia* More rapidly progressive Prolymphocytic leukemia Mantle cell lymphoma* Most rapidly progressive Acute lymphoblastic leukemia* * For more information, please see the free LLS publication about this disease. ** For more information about small cell lymphocytic lymphoma, please see the free LLS publication Non-Hodgkin Lymphoma. Large Granular Lymphocytic (LGL) Leukemia. LGL leukemia is another type of chronic leukemia of the lymphocytes. It is characterized by larger lymphocytes containing noticeable granules, which can be seen when the blood is examined under a microscope (see Figure 3, Panel C, on page 19). These are not features of cells in other types of CLL. LGL leukemia is either T-cell type or NK-cell type. The blood lymphocyte count is always elevated in CLL. However, it is often normal or low in LGL leukemia. Although the liver and spleen may be enlarged in LGL leukemia, the lymph nodes are not. This is another feature that distinguishes it from CLL. For patients with T-cell LGL leukemia, chemotherapy, if required, with lowdose methotrexate or cyclophosphamide, or treatment with cyclosporine, an immunomodulatory drug, may be helpful in improving the neutrophil count and the red cell count. Granulocyte-colony stimulating factor (G-CSF) may also be part of therapy to improve neutrophil counts, especially if an infection is present. Alemtuzumab (Campath®), which destroys large granular lymphocytes, is being studied in clinical trials as a potential treatment. NK-cell LGL leukemia is very resistant to therapy. Prolymphocytic Leukemia. This disease can be a B-cell or a T-cell type and features large numbers of lymphocytes in the blood. These lymphocytes are a mixture of small lymphocytes akin to CLL cells and large, more immatureappearing lymphocytes akin to acute lymphoblastic leukemia cells. Chronic Lymphocytic Leukemia I page 25
Page 1 and 2: Chronic Lymphocytic Leukemia JUNE D
Page 3 and 4: Table of Contents 2 Introduction 2
Page 5 and 6: along with a cancer diagnosis. LLS
Page 7 and 8: We’d Like to Hear From You. We ho
Page 9 and 10: etween herbicides used in Vietnam a
Page 11 and 12: infrequently, cause an increase in
Page 13 and 14: Chromosomal Changes. Certain chromo
Page 15 and 16: Treatment Current therapies do not
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: The National Cancer Institute-spons
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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