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Lymphoid Cells and Tissues01:18

Lymphoid Cells and Tissues

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Lymphoid cells and tissues are integral to the immune system, which is crucial in maintaining our body's defense against harmful pathogens. They form the building blocks of lymphoid organs, which include the spleen, thymus, and lymph nodes.
Lymphoid cells consist of various types of immune system cells. These include B and T lymphocytes, which are responsible for producing antibodies and killing infected cells, respectively. Dendritic cells act as messengers between the innate and adaptive...
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Immunoglobulin Gene Sequence Analysis In Chronic Lymphocytic Leukemia: From Patient Material To Sequence Interpretation
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"Smouldering" Chronic Lymphocytic Leukemia.

E Montserrat1, N Viñolas1, J C Reverter1

  • 1a Postgraduate School of Hematology "Farreras Valenti", University of Barcelona, Hospital Clinic, Barcelona, Spain.

Leukemia & Lymphoma
|July 28, 2016
PubMed
Summary

Identifying "smouldering" chronic lymphocytic leukemia (CLL) is crucial for withholding treatment. Smouldering CLL patients, characterized by specific criteria, show progression rates similar to controls, suggesting watchful waiting is appropriate.

Keywords:
Chronic lymphocytic leukemiaearly clinical stagesprognosis“smouldering” chronic lymphocytic leukemia

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Area of Science:

  • Hematology
  • Oncology
  • Clinical Prognostics

Background:

  • Current clinical staging systems for chronic lymphocytic leukemia (CLL) are insufficient for predicting disease progression in early-stage patients.
  • Distinguishing between "active" and "smouldering" disease in early-stage CLL is vital for appropriate treatment decisions, as treatment is often withheld in smouldering cases.

Purpose of the Study:

  • To define criteria for identifying "smouldering" chronic lymphocytic leukemia (CLL) in early-stage patients.
  • To assess the prognostic value of various clinical and biological factors in early-stage CLL.
  • To inform treatment strategies for early-stage CLL by differentiating between active and smouldering disease.

Main Methods:

  • Review of existing literature and clinical series defining "smouldering" CLL.
  • Analysis of patient characteristics including bone marrow infiltration, lymphocyte count, hemoglobin levels, and lymphocyte doubling time.
  • Consideration of Rai substages, chromosomal abnormalities, phenotypic studies, and sex as prognostic indicators.

Main Results:

  • "Smouldering" CLL patients (Binet's stage A) with moderate bone marrow infiltration, low lymphocyte counts, normal hemoglobin, and prolonged lymphocyte doubling time exhibit a low progression rate (approx. 15% at 5 years).
  • These "smouldering" CLL patients have a life expectancy comparable to matched controls.
  • Approximately 20-30% of all CLL patients meet the criteria for "smouldering" disease.

Conclusions:

  • Established criteria can identify a subset of early-stage CLL patients with "smouldering" disease who are unlikely to progress.
  • Treatment may not be beneficial for early-stage CLL patients, particularly those with "smouldering" disease, due to potential treatment-related morbidity and lack of survival advantage.
  • Further prospective studies are needed to refine the definition of "smouldering" CLL and confirm optimal management strategies.