Page 436 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

420 PART 6 ■ Neoplastic Disorders

BOX 22.2

Differential Diagnosis of Chronic

Lymphocytic Leukemia

BENIGN CAUSES
-Cell Associated

■ B cteri l, e.g., B

■ Vir l, e.g., in ectious ononucleosis

B-Cell Associated

■ Persistent polyclon l B-cell ly phocytosis

■ Hyperre ctive l ri l spleno eg ly

MALIGNANT B CELL

■ Monoclon l B-cell ly phocytosis

■ Proly phocytic leuke i (PLL)

■ H iry cell leuke i

FIGURE 22.1 Chronic ly phocytic leuke i . M ture cells pre- ■ Leuke ic ph se o non-Ho gkin ly pho

o in te in the chronic leuke i s. In this bloo s e r, typic l Follicul r ly pho
incre se in the nu ber o s u ge cells is seen. (Si ul tes gni- M ntle cell ly pho

f c tion 1,000×.) M rgin l zone ly pho

Ly phopl s cytic ly pho
Di use l rge cell ly pho

Decision to Treat
MALIGNANT T CELL
T e ecision to tre t p tient epen s on the st ge o the Proly phocytic leuke i

ise se, the presence o sy pto s, n the ise se ctiv- ■ A ult -cell leuke i /ly pho

ity. Only p tients in R i III n IV or Binet C st ges shoul ■ Séz ry syn ro e

be tre te . P tients in e rly st ges o CLL shoul only be ■ L rge gr nul r ly phocytic leuke i

tre te i sy pto s ssoci te with the ise se occur (e.g., ■

thre tening co plic tions ro spleen or liver enl rge ent Re erence: Greer JP, et l. (e .), Wintrobe’s Clinical Hematology, 13th e ,

n ly pho s th t c n pro uce co pression o the l rge 2014:1903.

b o in l vessels). High ise se ctivity is ef ne by ly -

phocyte oubling ti e o less th n 6 onths or by r pi ly

growing ly pho s. High ise se ctu lly is lso n in ic -

tion to tre t in the e rly st ges o the ise se. cyclophosph i e. T is pro uce response in up to 70%

o p tients but i not i prove surviv l. Co plete re is-
Historical Treatm ents sions re r re, n p rti l re issions re o short ur tion.

Origin lly, the f rst-line tre t ent o CLL in the 1960s con- Nucleosi e (purine) n logues, or ex ple, u r bine,

siste o lkyl ting gents, or ex ple, chlor bucil n pentost tin, n cl ribine, th t were popul r in the 1980s

FIGURE 22.2 wo sli es showing chronic ly phocytic leuke i . (Reprinte ro An erson S, Poulsen K.
Anderson’s Atlas o Hematology, Phil elphi , PA: Lippincott Willi s & Wilkins, 2003, with per ission.)