Chronic lymphocytic leukaemia (CLL).
This is a monoclonal proliferation of well-differentiated lymphocytes.
They are almost always B cells. The patient is usually over 40.
Men are affected twice as often as women are.
Staging (0-6) correlates with survival.
Symptoms: bleeding, weight loss, infection and anemia.
Signs: enlarged, rubbery, non-tender nodes. Late hepatosplenomegaly.
Film: lymphocytosis, normochromic normocytic anemia and thrombocytopenia.
Complications: autoimmune haemolysis, bacterial infections and bone marrow failure.
Treatment: chemotherapy: chlorambucil (decrease lymphocyte count).
Radiotherapy: use for relief of lymphadenopathy or splenomegaly.
Supportive care: transfusions, prophylactic antibiotics and occasionally IV immunoglobulins.
Reference: Counseling:Leukaemia, AML, CLL, CML and Leukaemia.
Chronic myeloid leukaemia (CML).
CML is characterized by uncontrolled proliferation of myeloid cells. It is a myeloproliferative disorder (feature: massive splenomegaly).
Mostly common in middle aged males.
Philadelphia chromosome: this is chromosome 22, which has lost about half of its long arm. In nearly all the cases this is translocated to the long arm of chromosome 9. This Philadelphia chromosome is present in granulocyte; RBC and platelet precursors in over 95% of those with CML. Those without Ph¹ have a particularly bad prognosis.
Symptoms: weight loss, tiredness, gout, fever, sweats, haemorrhage, abdominal pain. Signs: splenomegaly, hepatomegaly, anaemia and bruising.
Tests: WBC , Hb¯ or« , platelets variable, leucocyte alk phos¯ , plasma uric acid and alk phos , B12.
Natural history: variable, typically 2 phases. Chronic, lasting month or years of few, if any, symptoms followed by blast transformation with features of acute leukaemia and usually rapid death.
Treatment: Busulphan, a- interferon. BMT starting with chemotherapy and whole body radiotherapy. 50-60% of transplanted patients will be cured.