Chronic lymphocytic leukemia natural history, complications and prognosis: Difference between revisions

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Latest revision as of 15:50, 28 February 2019

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

Common complications of chronic lymphocytic leukemia include:^[1]^[2]^[3]^[4]

Richter's transformation
Recurrent infections
Anemia
- Autoimmune thrombocytopenia
- Red cell aplasia
- Chemotherapy-induced anemia
Immune thrombocytopenia
Colitis
Intussusception
Small intestinal bacterial contamination
Tumor lysis syndrome
Constrictive pericarditis

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	Older age at the time of diagnosis is associated with a worse prognosis.
Gender	Males are associated with a worse prognosis when compared to females.
Performance status	Patient's poor performance status is associated with a worse prognosis.
Stage	Binet stages B and C or Rai stages 2-4 are associated with a worse prognosis.
Lymphocyte doubling time	A rapid lymphocyte doubling time is associated with a worse prognosis.
Genetic mutations	Deletion of chromosome 17 short arm and chromosome 11 long arm are associated with a worse prognosis.
Prolymphocytes percent	An increased percentage of prolymphocytes is associated with a worse prongnosis.
Histological analysis	Diffuse histology on bone marrow aspiration is associated with a worse prognosis.
Lactate dehydrogenase (LDH) level	Elevated level of LDH is associated with a worse prognosis.
β2-microglobulin level	Elevated level of β2-microglobulin is associated with a worse prognosis.
Lymphocyte surface markers	Over expression of CD38 is associated with a worse prognosis.
Immunoglobulin (Ig)VH gene	The absence of IgVH gene mutation is associated with a worse prognosis.
Membrane-bound proteins	The expression of zeta-chain-associated protein kinase 70 (ZAP) is associated with a worse prognosis.

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.

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Template:WikiDoc Sources

[pmid25461996-1] 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.

[pmid107794222-2] 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.

[pmid8410123-3] 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.

[pmid17986663-4] 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-5] SEER Stat Fact Sheets: Chronic Lymphocytic Leukemia. National Cancer Institute (2015) http://seer.cancer.gov/statfacts/html/clyl.html Accessed on October, 12 2015

[pmid267489322-6] 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.

[pmid14576043-7] 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.

[pmid26748932-8] 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.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Chronic lymphocytic leukemia}}
+{{CMG}} {{AE}}{{HL}}
-{{CMG}}; {{AE}} {{RT}}
 ==Overview==
+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===
-The clinical course of [[chronic lymphocytic leukemia]] varies widely from patient to patient.  Some patients die early because of complications, but most patients survive for 5 - 10 yrs.  The course of the disease is benign initially but followed by terminal, progressive and resistant phase which lasts for 1 - 2 yrs.
+* 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.
 ===Complications===
-* [[Hypogammaglobulinemia]] leading to recurrent infection.
+* 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>
-* [[Autoimmune hemolytic anemia]] - IgG type
+:* [[Richter's transformation]]
-* Transformation to high grade [[lymphoma]]
+:* Recurrent [[infection]]s
-* [[Richter's transformation]]
+:* [[Anemia]]
-* Gastrointestinal (GI) involvement - [[intussusception]], small intestinal bacterial contamination, [[colitis]]
+:** [[Autoimmune]] [[thrombocytopenia]]
-* Increased risk of other cancers - [[melanoma]], lung and gastrointestinal cancers
+:** [[Red cells|Red cell]] [[aplasia]]
+:** [[Chemotherapy]]-induced [[anemia]]
+:* [[Immunity (medical)|Immune]] [[thrombocytopenia]]
+:* [[Colitis]]
+:* [[Intussusception]]
+:* [[Small intestinal]] [[bacterial]] [[contamination]]
+:* [[Tumor lysis syndrome]]
+:* [[Constrictive pericarditis]]
 ===Prognosis===
-The prognosis of chronic lymphocytic leukemia depends on:
+* [[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 [[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 [[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"
+| valign="top" |
+|+
+! style="background: #4479BA; width: 250px; color: #FFFFFF;" |'''Prognostic Factor'''
+! 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;" |
+:* 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;" |
+:* [[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;" |
+:* 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;" |
+:*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;" |
+:*A rapid [[lymphocyte]] doubling time is associated with a worse [[prognosis]].
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''[[Genetics|Genetic]] [[Mutation|mutations]]'''|| style="padding: 5px 5px; background: #F5F5F5;" |
+:*[[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" | '''[[Prolymphocyte|Prolymphocytes]] [[Percentage|percent]]'''|| style="padding: 5px 5px; background: #F5F5F5;" |
+:*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;" |
+:*[[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]] ([[Lactate dehydrogenase|LDH]]) level'''|| style="padding: 5px 5px; background: #F5F5F5;" |
+:*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;" |
+:*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;" |
+:*Over [[expression]] of [[CD38]] is associated with a worse [[prognosis]].
+|-
+| 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 stage of chronic lymphocytic leukemia, whether lymphocytes are spread throughout the bone marrow, whether the chronic lymphocytic leukemia progresses to lymphoma or prolymphocytic leukemia.
+|-
-* Treatment response: Whether the chronic lymphocytic leukemia patient gets better with treatment or has come back.
-* The patient's general health.
-Survival varies from 5 years to more than 25 years.
+| 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 70 kD|zeta-chain-associated protein kinase]] 70 ([[ZAP-70|ZAP]]) is associated with a worse [[prognosis]].
+|}
 ==References==

v t e Myeloid Hematological malignancy/leukemia histology (ICD-O 9590-9989, C81-C96, 200-208)
CFU-GM/ and other granulocytes	Template:Navbox subgroup
MEP	Template:Navbox subgroup
CFU-Mast	Mastocytoma (Mast cell leukemia, Mast cell sarcoma, Systemic mastocytosis)
Multiple/unknown	AML (Acute panmyelosis with myelofibrosis, Myeloid sarcoma) · MP (Myelofibrosis) · Acute biphenotypic leukaemia
See also hematology, lymphoid malignancy