Chronic lymphocytic leukemia natural history, complications and prognosis: Difference between revisions
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{{CMG}} {{AE}}{{HL}} | {{CMG}} {{AE}}{{HL}} | ||
==Overview== | ==Overview== | ||
Most patients with chronic lymphocytic leukemia are initially asymptomatic. If left untreated, patients with chronic lymphocytic leukemia may progress to develop [[weight loss]], [[fever]], and [[lymph node]]s swelling. Common complications of chronic lymphocytic leukemia include [[immunodeficiency]], [[warm autoimmune hemolytic anemia]], and [[Richter's transformation]]. | Most [[Patient|patients]] with chronic lymphocytic leukemia are initially [[asymptomatic]]. If left untreated, [[Patient|patients]] with chronic lymphocytic leukemia may progress to develop [[weight loss]], [[fever]], and [[lymph node]]s swelling. Common complications of chronic lymphocytic leukemia include [[immunodeficiency]], [[warm autoimmune hemolytic anemia]], and [[Richter's transformation]]. [[Prognosis]] is generally good, and the 5-year [[survival rate]] of [[Patient|patients]] with chronic lymphocytic leukemia is 81.7%. | ||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
* Most patients with chronic lymphocytic leukemia are initially asymptomatic. | * Most [[Patient|patients]] with chronic lymphocytic leukemia are initially [[asymptomatic]]. | ||
* If left untreated, patients with chronic lymphocytic leukemia may progress to develop [[weight loss]], [[fever]], and [[lymph node]]s swelling. | * If left untreated, patients with chronic lymphocytic leukemia may progress to develop [[weight loss]], [[fever]], and [[lymph node]]s swelling. | ||
===Complications=== | ===Complications=== | ||
* Common complications of chronic lymphocytic leukemia include: | * Common complications of chronic lymphocytic leukemia include:<ref name="pmid25461996">{{cite journal| author=Nabhan C, Rosen ST| title=Chronic lymphocytic leukemia: a clinical review. | journal=JAMA | year= 2014 | volume= 312 | issue= 21 | pages= 2265-76 | pmid=25461996 | doi=10.1001/jama.2014.14553 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25461996 }} </ref><ref name="pmid107794222">{{cite journal |vauthors=Mauro FR, Foa R, Cerretti R, Giannarelli D, Coluzzi S, Mandelli F, Girelli G |title=Autoimmune hemolytic anemia in chronic lymphocytic leukemia: clinical, therapeutic, and prognostic features |journal=Blood |volume=95 |issue=9 |pages=2786–92 |date=May 2000 |pmid=10779422 |doi= |url=}}</ref><ref name="pmid8410123">{{cite journal |vauthors=Robertson LE, Pugh W, O'Brien S, Kantarjian H, Hirsch-Ginsberg C, Cork A, McLaughlin P, Cabanillas F, Keating MJ |title=Richter's syndrome: a report on 39 patients |journal=J. Clin. Oncol. |volume=11 |issue=10 |pages=1985–9 |date=October 1993 |pmid=8410123 |doi=10.1200/JCO.1993.11.10.1985 |url=}}</ref><ref name="pmid17986663">{{cite journal |vauthors=Visco C, Ruggeri M, Laura Evangelista M, Stasi R, Zanotti R, Giaretta I, Ambrosetti A, Madeo D, Pizzolo G, Rodeghiero F |title=Impact of immune thrombocytopenia on the clinical course of chronic lymphocytic leukemia |journal=Blood |volume=111 |issue=3 |pages=1110–6 |date=February 2008 |pmid=17986663 |doi=10.1182/blood-2007-09-111492 |url=}}</ref> | ||
:* [[Richter's transformation]] | :* [[Richter's transformation]] | ||
:* Recurrent [[infection]]s | :* Recurrent [[infection]]s | ||
:* [[ | :* [[Anemia]] | ||
:* [[ | :** [[Autoimmune]] [[thrombocytopenia]] | ||
:** [[Red cells|Red cell]] [[aplasia]] | |||
:** [[Chemotherapy]]-induced [[anemia]] | |||
:* [[Immunity (medical)|Immune]] [[thrombocytopenia]] | |||
:* [[Colitis]] | :* [[Colitis]] | ||
:* [[Intussusception]] | :* [[Intussusception]] | ||
| Line 23: | Line 26: | ||
===Prognosis=== | ===Prognosis=== | ||
* Prognosis is generally good, and the 5-year survival rate of patients with chronic lymphocytic leukemia is 81.7%.<ref name="seer"> SEER Stat Fact Sheets: Chronic Lymphocytic Leukemia. National Cancer Institute (2015) http://seer.cancer.gov/statfacts/html/clyl.html Accessed on October, 12 2015</ref> | * [[Prognosis]] is generally good, and the 5-year survival rate of [[Patient|patients]] with chronic lymphocytic leukemia is 81.7%.<ref name="seer">SEER Stat Fact Sheets: Chronic Lymphocytic Leukemia. National Cancer Institute (2015) http://seer.cancer.gov/statfacts/html/clyl.html Accessed on October, 12 2015</ref> | ||
* Common prognostic factors for chronic lymphocytic leukemia patients include age, [[tumor]] stage, and the presence of certain [[genetic mutation]]s. | * Common [[prognostic]] factors for chronic lymphocytic leukemia [[Patient|patients]] include age, [[tumor]] stage, and the presence of certain [[genetic mutation]]s.<ref name="pmid267489322">{{cite journal |vauthors=Chen C, Puvvada S |title=Prognostic Factors for Chronic Lymphocytic Leukemia |journal=Curr Hematol Malig Rep |volume=11 |issue=1 |pages=37–42 |date=February 2016 |pmid=26748932 |doi=10.1007/s11899-015-0294-x |url=}}</ref> | ||
* The table below lists prognostic factors for chronic lymphocytic leukemia patients:<ref name=" | * The table below lists [[prognostic]] factors for chronic lymphocytic leukemia [[Patient|patients]]:<ref name="pmid14576043">{{cite journal |vauthors=Shanafelt TD, Geyer SM, Kay NE |title=Prognosis at diagnosis: integrating molecular biologic insights into clinical practice for patients with CLL |journal=Blood |volume=103 |issue=4 |pages=1202–10 |date=February 2004 |pmid=14576043 |doi=10.1182/blood-2003-07-2281 |url=}}</ref><ref name="pmid26748932">{{cite journal |vauthors=Chen C, Puvvada S |title=Prognostic Factors for Chronic Lymphocytic Leukemia |journal=Curr Hematol Malig Rep |volume=11 |issue=1 |pages=37–42 |date=February 2016 |pmid=26748932 |doi=10.1007/s11899-015-0294-x |url=}}</ref><ref name="pmid25461996" /> | ||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" | {| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" | ||
|valign=top| | | valign="top" | | ||
|+ | |+ | ||
! style="background: #4479BA; width: 250px; color: #FFFFFF;"|'''Prognostic Factor''' | ! style="background: #4479BA; width: 250px; color: #FFFFFF;" |'''Prognostic Factor''' | ||
! style="background: #4479BA; width: 600px; color: #FFFFFF;"|'''Description''' | ! style="background: #4479BA; width: 600px; color: #FFFFFF;" |'''Description''' | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Age'''|| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''[[Age]]'''|| style="padding: 5px 5px; background: #F5F5F5;" | | ||
:* Older age at the time of diagnosis is associated with a worse prognosis. | :* Older age at the time of [[diagnosis]] is associated with a worse [[prognosis]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Gender'''|| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Gender'''|| style="padding: 5px 5px; background: #F5F5F5;" | | ||
:* Males are associated with a worse prognosis when compared to females. | :* [[Male|Males]] are associated with a worse [[prognosis]] when compared to [[Female|females]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''[[Performance status]]'''|| style="padding: 5px 5px; background: #F5F5F5;" | | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Performance status'''|| style="padding: 5px 5px; background: #F5F5F5;"| | :* Patient's poor [[performance status]] is associated with a worse [[prognosis]]. | ||
:* Patient's poor [[performance status]] is associated with a worse prognosis. | |||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Stage'''|| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''Stage'''|| style="padding: 5px 5px; background: #F5F5F5;" | | ||
:*Binet stages B and C or Rai stages 2-4 are associated with a worse prognosis. | :*Binet stages B and C or Rai stages 2-4 are associated with a worse [[prognosis]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Lymphocyte doubling time'''|| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''[[Lymphocyte]] [[doubling time]]'''|| style="padding: 5px 5px; background: #F5F5F5;" | | ||
:*A rapid [[lymphocyte]] doubling time is associated with a worse prognosis. | :*A rapid [[lymphocyte]] doubling time is associated with a worse [[prognosis]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Genetic mutations'''|| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''[[Genetics|Genetic]] [[Mutation|mutations]]'''|| style="padding: 5px 5px; background: #F5F5F5;" | | ||
:*Deletion of [[chromosome 17]] short arm and [[chromosome 11]] long arm are associated with a worse prognosis. | :*[[Deletion (genetics)|Deletion]] of [[chromosome 17]] short arm and [[chromosome 11]] long arm are associated with a worse [[prognosis]]. | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Prolymphocytes percent'''|| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''[[Prolymphocyte|Prolymphocytes]] [[Percentage|percent]]'''|| style="padding: 5px 5px; background: #F5F5F5;" | | ||
:*An increased percentage of [[prolymphocyte]]s is associated with a worse prongnosis. | :*An increased percentage of [[prolymphocyte]]s is associated with a worse prongnosis. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Histological analysis'''|| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''[[Histological]] [[analysis]]'''|| style="padding: 5px 5px; background: #F5F5F5;" | | ||
:*Diffuse [[histology]] on [[bone marrow aspiration]] is associated with a worse prognosis. | :*[[Diffuse]] [[histology]] on [[bone marrow aspiration]] is associated with a worse [[prognosis]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Lactate dehydrogenase (LDH) level'''|| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''[[Lactate]] [[dehydrogenase]] ([[Lactate dehydrogenase|LDH]]) level'''|| style="padding: 5px 5px; background: #F5F5F5;" | | ||
:*Elevated level of [[LDH]] is associated with a worse prognosis. | :*Elevated level of [[LDH]] is associated with a worse [[prognosis]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''β2-microglobulin level '''|| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''β2-microglobulin level '''|| style="padding: 5px 5px; background: #F5F5F5;" | | ||
:*Elevated level of β2-microglobulin | :*Elevated level of β2-microglobulin is associated with a worse [[prognosis]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Lymphocyte surface markers'''|| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''[[Lymphocyte]] surface markers'''|| style="padding: 5px 5px; background: #F5F5F5;" | | ||
:*Over expression of [[CD38]] is associated with a worse prognosis. | :*Over [[expression]] of [[CD38]] is associated with a worse [[prognosis]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Immunoglobulin (Ig)VH gene'''|| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''[[Immunoglobulin]] (Ig)[[VHL gene|VH gene]]'''|| style="padding: 5px 5px; background: #F5F5F5;" | | ||
:*The absence of IgVH [[gene]] mutation is associated with a worse prognosis. | :*The absence of IgVH [[gene]] [[mutation]] is associated with a worse [[prognosis]]. | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align=center | '''Membrane-bound proteins'''|| style="padding: 5px 5px; background: #F5F5F5;"| | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''[[Membrane]]-bound [[Protein|proteins]]'''|| style="padding: 5px 5px; background: #F5F5F5;" | | ||
:*The expression of zeta-chain-associated protein kinase 70 (ZAP) is associated with a worse prognosis. | :*The [[expression]] of [[Zeta-chain-associated protein 70 kD|zeta-chain-associated protein kinase]] 70 ([[ZAP-70|ZAP]]) is associated with a worse [[prognosis]]. | ||
|} | |} | ||
Latest revision as of 15:50, 28 February 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]
Overview
Most patients with chronic lymphocytic leukemia are initially asymptomatic. If left untreated, patients with chronic lymphocytic leukemia may progress to develop weight loss, fever, and lymph nodes swelling. Common complications of chronic lymphocytic leukemia include immunodeficiency, warm autoimmune hemolytic anemia, and Richter's transformation. Prognosis is generally good, and the 5-year survival rate of patients with chronic lymphocytic leukemia is 81.7%.
Natural History, Complications and Prognosis
Natural History
- Most patients with chronic lymphocytic leukemia are initially asymptomatic.
- If left untreated, patients with chronic lymphocytic leukemia may progress to develop weight loss, fever, and lymph nodes swelling.
Complications
Prognosis
- Prognosis is generally good, and the 5-year survival rate of patients with chronic lymphocytic leukemia is 81.7%.[5]
- Common prognostic factors for chronic lymphocytic leukemia patients include age, tumor stage, and the presence of certain genetic mutations.[6]
- The table below lists prognostic factors for chronic lymphocytic leukemia patients:[7][8][1]
| Prognostic Factor | Description |
|---|---|
| Age | |
| Gender | |
| Performance status |
|
| Stage |
|
| Lymphocyte doubling time |
|
| Genetic mutations |
|
| Prolymphocytes percent |
|
| Histological analysis |
|
| Lactate dehydrogenase (LDH) level | |
| β2-microglobulin level |
|
| Lymphocyte surface markers |
|
| Immunoglobulin (Ig)VH gene | |
| Membrane-bound proteins |
|
References
- ↑ 1.0 1.1 Nabhan C, Rosen ST (2014). "Chronic lymphocytic leukemia: a clinical review". JAMA. 312 (21): 2265–76. doi:10.1001/jama.2014.14553. PMID 25461996.
- ↑ Mauro FR, Foa R, Cerretti R, Giannarelli D, Coluzzi S, Mandelli F, Girelli G (May 2000). "Autoimmune hemolytic anemia in chronic lymphocytic leukemia: clinical, therapeutic, and prognostic features". Blood. 95 (9): 2786–92. PMID 10779422.
- ↑ Robertson LE, Pugh W, O'Brien S, Kantarjian H, Hirsch-Ginsberg C, Cork A, McLaughlin P, Cabanillas F, Keating MJ (October 1993). "Richter's syndrome: a report on 39 patients". J. Clin. Oncol. 11 (10): 1985–9. doi:10.1200/JCO.1993.11.10.1985. PMID 8410123.
- ↑ Visco C, Ruggeri M, Laura Evangelista M, Stasi R, Zanotti R, Giaretta I, Ambrosetti A, Madeo D, Pizzolo G, Rodeghiero F (February 2008). "Impact of immune thrombocytopenia on the clinical course of chronic lymphocytic leukemia". Blood. 111 (3): 1110–6. doi:10.1182/blood-2007-09-111492. PMID 17986663.
- ↑ SEER Stat Fact Sheets: Chronic Lymphocytic Leukemia. National Cancer Institute (2015) http://seer.cancer.gov/statfacts/html/clyl.html Accessed on October, 12 2015
- ↑ Chen C, Puvvada S (February 2016). "Prognostic Factors for Chronic Lymphocytic Leukemia". Curr Hematol Malig Rep. 11 (1): 37–42. doi:10.1007/s11899-015-0294-x. PMID 26748932.
- ↑ Shanafelt TD, Geyer SM, Kay NE (February 2004). "Prognosis at diagnosis: integrating molecular biologic insights into clinical practice for patients with CLL". Blood. 103 (4): 1202–10. doi:10.1182/blood-2003-07-2281. PMID 14576043.
- ↑ Chen C, Puvvada S (February 2016). "Prognostic Factors for Chronic Lymphocytic Leukemia". Curr Hematol Malig Rep. 11 (1): 37–42. doi:10.1007/s11899-015-0294-x. PMID 26748932.