Protocols - Hemorio

RAI STAGING:
STAGE DESCRIPTION RISK
0 Isolated lymphocytosis Good
I lymphadenopathy Intermediate
II hepatomegaly and/or splenomegaly Intermediate
III Hb< 11g/dL High
IV platelets< 100,000/mm 3 High
Note: other causes of anemia or plateletpenia must be excluded.
PROGNOSTIC FACTORS:
FAVORABLE UNFAVORABLE
Sequencing DNA Vh >2% mutation ≤ 2% mutation
ZAP70 (cytometry) >20% of the cells leukemic negative positive
CD38> 30% negative positive
17p- (FISH) absent present
11q- (FISH) absent present
TREATMENT INDICATIONS
- progressive medullar failure by lymphomatous infiltration: development or worsening of anemia or
thrombocytopenia (exclude other cause of anemia / thrombocytopenia);
- progressive or massive lymphadenopathy (> 10 cm);
- progressive or massive splenomegaly (6 cm below RCD);
- progressive lymphocytosis: increase > 50% in 2 months or time of double lymphocytic counting < 6
months;
- systemic symptoms: weight loss >10% last 6 months, fever >38 o in the last 2 weeks, nocturnal sweating
and extreme fatigue. Other causes of these symptoms must be excluded, such as, for example, infection;
- self-immune cytopenias;
- recurrent infections;
- histological change.
RESPONSE CRITERIA (NCI):
FULL RESPONSE PARTIAL RESPONSE PROGRESSION
Physical exam normal decrease ≥ 50% increase ≥ 50%
Symptoms absent
Lymphocytes
(x106 /L)
≤4,000 decrease ≥50% from baseline increase >50%
Neutrophils (x106 /L) ≥1,500
≥1,500 or increase ≥50% from
121
baseline
Platelets (x106 /L) >100,000
≥100,000 or increase ≥ 50% from
baseline
Hemoglobin (g/dL) >11 (with no transfusion) >11 or increase ≥ 50%
Myelogram