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

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Revision as of 21:24, 31 January 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%.^[1]

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:^[2]

Prognosis

Prognosis is generally good, and the 5-year survival rate of patients with chronic lymphocytic leukemia is 81.7%.^[1]
Common prognostic factors for chronic lymphocytic leukemia patients include age, tumor stage, and the presence of certain genetic mutations.
The table below lists prognostic factors for chronic lymphocytic leukemia patients:^[2]^[3]


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 level 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 SEER Stat Fact Sheets: Chronic Lymphocytic Leukemia. National Cancer Institute (2015) http://seer.cancer.gov/statfacts/html/clyl.html Accessed on October, 12 2015
↑ ^2.0 ^2.1 Nabhan C, Rosen ST (2014). "Chronic lymphocytic leukemia: a clinical review". JAMA. 312 (21): 2265–76. doi:10.1001/jama.2014.14553. PMID 25461996.
↑ Hoffbrand V, Moss P. Essential Haematology. John Wiley & Sons; 2011

Template:Hematology

Template:WikiDoc Sources

[seer-1] 1.0 ^1.1 SEER Stat Fact Sheets: Chronic Lymphocytic Leukemia. National Cancer Institute (2015) http://seer.cancer.gov/statfacts/html/clyl.html Accessed on October, 12 2015

[pmid25461996-2] 2.0 ^2.1 Nabhan C, Rosen ST (2014). "Chronic lymphocytic leukemia: a clinical review". JAMA. 312 (21): 2265–76. doi:10.1001/jama.2014.14553. PMID 25461996.

[3] Hoffbrand V, Moss P. Essential Haematology. John Wiley & Sons; 2011

[1]

[2]

[3]

@@ Line 3: / Line 3: @@
 {{CMG}} {{AE}}{{HL}}
 ==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]].<ref name="wiki">Chronic Lymphocytic Leukimea. Wikipedia (2015) https://en.wikipedia.org/wiki/B-cell_chronic_lymphocytic_leukemia Accessed on October ,12 2015</ref> 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>
+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]]. 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>
 ==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 node]]s swelling.<ref name="wiki">Chronic Lymphocytic Leukimea. Wikipedia (2015) https://en.wikipedia.org/wiki/B-cell_chronic_lymphocytic_leukemia Accessed on October ,12 2015</ref>
+* If left untreated, patients with chronic lymphocytic leukemia may progress to develop [[weight loss]], [[fever]], and [[lymph node]]s swelling.
 ===Complications===
-* Common complications of chronic lymphocytic leukemia include:<ref name="wiki">Chronic Lymphocytic Leukimea. Wikipedia (2015) https://en.wikipedia.org/wiki/B-cell_chronic_lymphocytic_leukemia Accessed on October ,12 2015</ref><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>
+* 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>
 :* [[Richter's transformation]]
 :* Recurrent [[infection]]s
@@ Line 23: / Line 23: @@
 ===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 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.
 * The table below lists prognostic factors for chronic lymphocytic leukemia patients:<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>Hoffbrand V, Moss P. Essential Haematology. John Wiley & Sons; 2011</ref>
 {| 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.
 |-
-| 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.
 |-
+| 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.
 |-
-| 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.
 |-
-| 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.
 |-
-| 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" | '''Genetic mutations'''|| style="padding: 5px 5px; background: #F5F5F5;" |
 :*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" | '''Prolymphocytes 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;"|
+| 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 (LDH) level'''|| style="padding: 5px 5px; background: #F5F5F5;"|
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | '''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;"|
+| 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 level 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.
 |-
-| 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)VH gene'''|| style="padding: 5px 5px; background: #F5F5F5;" |
 :*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 proteins'''|| style="padding: 5px 5px; background: #F5F5F5;" |
 :*The expression of zeta-chain-associated protein kinase 70 (ZAP) is associated with a worse prognosis.
 |}

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