Chronic lymphocytic leukemia - Revision history

Aidan: rearranged

2020-07-30T17:19:58Z

rearranged

← Older revision		Revision as of 17:19, 30 July 2020
Line 1:		Line 1:
	== ~~Epidemiology~~ ==		== Background ==

			===Epidemiology===
⚫	* Most common leukemia in adults
⚫	* Older adults, median age 70, but can present in anyone over 30
⚫	* More often men than women (2:1)

		⚫	*Most common leukemia in adults
⚫	== Clinical Manifestations ==
		⚫	*Older adults, median age 70, but can present in anyone over 30
		⚫	*More often men than women (2:1)

		⚫	=== Staging (RAI) ===
⚫	* Usually feel well until incidentally discovered on CBC with lymphocytosis
⚫	* Can present with painless lymphadenopathy, especially cervical, that waxes and wanes
⚫	* Less than 10% present with consitutional symptoms
⚫	** Weight loss >10% within the last 6 months
⚫	** Fevers for 2 weeks without infection
⚫	** Drenching night sweats
⚫	** Fatigue
⚫	* On exam, often have lymphadenopathy (50-90%), splenomegaly, hepatomegaly, and leukemia cutis (skin involvement)

		⚫	*'''Low risk (Stage 0):''' lymphocytosis alone
⚫	== Staging (RAI) ==
		⚫	*'''Intermediate risk (Stage I-II):''' lymphocytosis with lymphadenopathy, with or without hepatosplenomegaly
		⚫	*'''High risk (Stage III-IV):''' lymphocytosis with anemia or thrombocytopenia

		⚫	==Clinical Manifestations==
⚫	* '''Low risk (Stage 0):''' lymphocytosis alone
⚫	* '''Intermediate risk (Stage I-II):''' lymphocytosis with lymphadenopathy, with or without hepatosplenomegaly
⚫	* '''High risk (Stage III-IV):''' lymphocytosis with anemia or thrombocytopenia

		⚫	*Usually feel well until incidentally discovered on CBC with lymphocytosis
⚫	== Management ==
		⚫	*Can present with painless lymphadenopathy, especially cervical, that waxes and wanes
		⚫	*Less than 10% present with consitutional symptoms
		⚫	**Weight loss >10% within the last 6 months
		⚫	**Fevers for 2 weeks without infection
		⚫	**Drenching night sweats
		⚫	**Fatigue
		⚫	*On exam, often have lymphadenopathy (50-90%), splenomegaly, hepatomegaly, and leukemia cutis (skin involvement)

		⚫	=== Complications ===
⚫	* Active surveillance is appropriat for most patients
⚫	* Primary indication for treatment is the presence of symptoms
⚫	** Progressive bone marrow failure not due to autoimmune destruction
⚫	** Massive or symptomatic splenomegaly (≥6 cm below the costal margin)
⚫	** Massive or symptomatic lymphadenopathy (≥10 cm)
⚫	** Autoimmune cytopenias not responsive to other treatment
⚫	** Constitutional symptoms
⚫	* First-line: fludarabine, cyclophosphamide, and rituximab (FCR)
⚫	* If older with comorbidities: chlorambucil with obinutuzumab, or bendamustine with rituximab (BR)

		⚫	*Infection is the major complication and is a common cause of death
⚫	== Complications ==
		⚫	*Also at risk for other malignancies: skin cancer, prostate cancer, and breast cancer
		⚫	*Can develop autoimmune cytopenias, most commonly an autoimmune hemolytic anemia
		⚫	*Can transform to acute lymphoma, most commonly DLBCL (Richter's transformation) at a rate of 0.5% per year

		⚫	==Management==
⚫	* Infection is the major complication and is a common cause of death

⚫	* Also at risk for other malignancies: skin cancer, prostate cancer, and breast cancer
		⚫	*Active surveillance is appropriat for most patients
⚫	* Can develop autoimmune cytopenias, most commonly an autoimmune hemolytic anemia
		⚫	*Primary indication for treatment is the presence of symptoms
⚫	* Can transform to acute lymphoma, most commonly DLBCL (Richter's transformation) at a rate of 0.5% per year
		⚫	**Progressive bone marrow failure not due to autoimmune destruction
		⚫	**Massive or symptomatic splenomegaly (≥6 cm below the costal margin)
		⚫	**Massive or symptomatic lymphadenopathy (≥10 cm)
		⚫	**Autoimmune cytopenias not responsive to other treatment
		⚫	**Constitutional symptoms
		⚫	*First-line: fludarabine, cyclophosphamide, and rituximab (FCR)
		⚫	*If older with comorbidities: chlorambucil with obinutuzumab, or bendamustine with rituximab (BR)

	[[Category:Hematology]]		[[Category:Hematology]]

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-14T23:53:56Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 23:53, 14 July 2020
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	* More often men than women (2:1)		* More often men than women (2:1)

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	* Usually feel well until incidentally discovered on CBC with lymphocytosis		* Usually feel well until incidentally discovered on CBC with lymphocytosis

Maintenance script: Imported from text file

2020-07-04T01:17:28Z

Imported from text file

New page

== Epidemiology ==

* Most common leukemia in adults
* Older adults, median age 70, but can present in anyone over 30
* More often men than women (2:1)

== Clinical Presentation ==

* Usually feel well until incidentally discovered on CBC with lymphocytosis
* Can present with painless lymphadenopathy, especially cervical, that waxes and wanes
* Less than 10% present with consitutional symptoms
** Weight loss >10% within the last 6 months
** Fevers for 2 weeks without infection
** Drenching night sweats
** Fatigue
* On exam, often have lymphadenopathy (50-90%), splenomegaly, hepatomegaly, and leukemia cutis (skin involvement)

== Staging (RAI) ==

* '''Low risk (Stage 0):''' lymphocytosis alone
* '''Intermediate risk (Stage I-II):''' lymphocytosis with lymphadenopathy, with or without hepatosplenomegaly
* '''High risk (Stage III-IV):''' lymphocytosis with anemia or thrombocytopenia

== Management ==

* Active surveillance is appropriat for most patients
* Primary indication for treatment is the presence of symptoms
** Progressive bone marrow failure not due to autoimmune destruction
** Massive or symptomatic splenomegaly (≥6 cm below the costal margin)
** Massive or symptomatic lymphadenopathy (≥10 cm)
** Autoimmune cytopenias not responsive to other treatment
** Constitutional symptoms
* First-line: fludarabine, cyclophosphamide, and rituximab (FCR)
* If older with comorbidities: chlorambucil with obinutuzumab, or bendamustine with rituximab (BR)

== Complications ==

* Infection is the major complication and is a common cause of death
* Also at risk for other malignancies: skin cancer, prostate cancer, and breast cancer
* Can develop autoimmune cytopenias, most commonly an autoimmune hemolytic anemia
* Can transform to acute lymphoma, most commonly DLBCL (Richter's transformation) at a rate of 0.5% per year

[[Category:Hematology]]
[[Category:Oncology]]