Thursday, October 8, 2009

Leukemia

Chronic Limphocytic Leukemia (CLL)


Chronic Limphocytic Leukemia. (CLL)


Definition
Cronic Limphocytic Leukemia (CLL) is an malignancy of haematologic which is signed with Clonal ploriferation and accumulation of neoplastic limphocyte B in blood, bone marrow, limphonodes, splen, liver, & other organs. The symptoms can include lymphocytosis, limphadenophaty, and splenomegali. about 95% CLL is cell B neoplasm. and the others is cell T neoplasm.


Epidemiology
the average of patients's age when diagnosed are 65 years old, just 10-15% less then 50 years old. CLL increased risk occurs with age. relative risk ratio between old men and the old women are 2,8 : 1. the most patients are caucasian race and in middle income.
some patients with CLL have normal life, and the others die after 5 years later since diagnosed.


Cause
CLL cause still unknown. the possibilities are chromosome abnormalities, oncogen, & retrovirus (RNA tumour virus). about 50% CLL patients have sitogenic abnormalities, especially trisomy 12, chromosomal abnormalities 13 in line q14 (RB-1 suppressor gene location) , deletions of chromosomes 6 and 11. this is good detection in fluorescence in situ, hibridation than sitogenik conventional analysis.


Diagnosis
Clinical manifestation
in early diagnosis, most of CLL patients are asymptomatic. limphadenopathy generalisata, loss of weight and fatigue are the most found in patients with symptoms. Another symptoms include anorexia and decreased in exercise capacity. fever, sweat at night, and infection are rare in early stage and become worst in the next stage. Limphadenopathy, splenomegaly and hepatomegaly found in asymptomatic patients, when diagnosed because of cell B neoplastic accumulation.


Physical Examinations
lymphadenopathy is usually found in physical examinations. About 50% patients have lymphadenopathy and/or hepatosplenomegaly. with the progressiveness of CLL, the massive of limphadenopathy can cause obstructuve icterus, oudem in lower extremity, partial intestine obstructive. pleural effusion or acites related with bad prognosis.


Diagnostic Criteria
Patognomonic sign of CLL is increasing in the number of leukocytes with small lymphocytosis about 95%. Examination peripheral blood picture is needed to make good diagnosis. Infiltration lymphocytes in bone marrow (>30% lymphocytes).
CLL can be diagnosed if there is increase of absolute lymphocites in blood (>5.000/uL) and its morphology also immunophenotype showing specific picture.


Differensial Diagnosis
  • Hairy cell leukemia
  • Prolymphocytic Leukemia
  • Mantle cell lymphoma
  • Cell T cronic Leukemia
  • LGL Leukemia
  • mature cell T Leukemia
  • etc
kind of Complications
  1. Infection
  2. Hypogamaglobulinemia
    found in more than
    66% patients in the end of this disease.
  3. It may transform into aggressive lymphoid malignancy
  4. Secondary malignancy


Therapy
The Therapy for this desease may include..
  • Chemotherapy
  • Radiotherapy - Radiotherapy for This patients just palliative treatment. About 50-90% Patients show that the limpha become smaller size and reducing their pain after this treatment .
  • Splenectomy - indication for Sympthomatic massive Splenomegaly, Sitopenia autoimune , and hiper splenism
The New treatment include
  • Monoclonal Antibody


Source: for more informations see Buku Ajar Ilmu Penyakit Dalam Jilid II Edisi IV page 735-38 ( Text Book)




here, another Review about Cancer symptoms

1 comments:

Hairy cell leukemia causes said...

Hairy Cell Leukemia is a type of blood cancer wherein there is excessive production of the B cells or lymphocytes. It can occur due to the presence of a flaw in one’s DNA. It can occur to individuals exposed to radiation, employed in farming and petroleum, exposed to sawdust etc. If anyone observes symptoms of it, should consult doctor immediately.