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CHRONIC LEUKEMIA

Overview
Definition Classification Clinical manifestation Diagnosis Principle of treatment Summary

Leukemia
malignancy the blood and blood-forming organs, causing an accumulation of dysfunctional cells and loss of cell division regulation.

Classification of leukemia
1. Dominant cell affected a) Lymphoid b) Myeloid 2. The point at which cell maturation is arrested a) Acute b) Chronic CLL, CML

Stem cell hematopoiesis

Incidence
CLL Population Age Peak age Gender 4 per 100, 000 per year > 50 years old 60 years old Male CML 1 per 100, 000 per year 20 60 years old 50 60 years old Male

Clinical manifestation
CLL CML
early chronic leukaemia, the leukemia cells function almost normally; symptoms may not appear for a long time. (asymptomatic) Symptoms 1. Feeling very tired 2. Early satiety & abdominal discomfort 3. Weight loss for unknown reason 4. Fever and infection 5. Pain below the ribs on the left side. 6. Bone and joints pain 7. Night sweats 8. Painless swelling of the lymph nodes in the neck, underarm, stomach, or groin 1. 2. 3. 4. 5. Signs Pallor Splenomegaly Hepatomegaly Bleeding tendency (petechiae) Generalized lymphadenopathy

Diagnosis
CLL CML

FBC

absolute lymphocytosis (> 5000 B-lymphocytes/ L) for more than 3 months


presence of smudge cells (artifacts from lymphocytes damaged during the slide preparation)

in mature granulocytes total WBC count of 20,000-60,000 cells/L


typical leukoerythroblastic blood picture, with circulating immature cells from the bone marrow Hypercellular with expansion of the myeloid cell line and its progenitor cells. Prominent Megakaryocytes Philadelphia chromosome (+) in the cytogenetic studies of the bone marrow cells

Peripheral blood smear

Bone Marrow analysis not required in all cases to establish the diagnosis and assess other complicating features (anemia and thrombocytopenia).

Smudge cells in CLL

Typical leukoerythroblastic in CML

Philadelphia chromosome found in ch 9 and ch 22

Treatment
1. 2. 3. Supportive care Chemotherapy oral and intravenous. Monoclonal antibody therapy
proteins infused into the body to target antigens on CLL cells. The antibodies bind to cancer cells and activate mechanisms that destroy them.

4. 5.

Chemo-immunotherapy Stem-cell transplantation

Summary
1) Chronic leukemia is the malignancy of blood and the blood forming organs with insidious onset and slow progression. 2) Chronic leukemia is divided into CML and CLL. 3) Clinical manifestations result from the defect in either lymphoid or myeloid lineage. 4) Diagnosis is made based on FBC, peripheral blood smear and bone marrow analysis. 5) Treatment: supportive, chemotherapy, monoclonal antibody, chemo-immunotherapy, and stem cell transplantation.

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