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[Current principles of diagnosis and treatment of chronic lymphocytic B-cell leukemia]
1Pécsi Orvostudományi Egyetem I. sz. Belgyógyászati Klinika.
Insights
Chronic lymphocytic leukemia (CLL) is a common blood cancer in adults, primarily affecting older individuals. Current treatments focus on chemotherapy, with stem cell transplantation offering a potential cure for some patients.
Area of Science:
- Hematology
- Oncology
- Immunology
Context:
- Chronic lymphocytic leukemia (CLL) is the most prevalent leukemia in Western countries, accounting for 30-40% of all leukemia cases.
- CLL typically manifests in individuals aged 60-65 and is characterized by the accumulation of abnormal B-lymphocytes.
Purpose:
- This review provides an overview of recent advancements in the diagnosis and treatment of chronic lymphocytic leukemia.
- It aims to summarize current therapeutic strategies and their efficacy.
Summary:
- The clinical presentation of CLL is primarily due to the proliferation of CD5-positive B-lymphocytes.
- Genetic factors are strongly implicated in CLL etiology, while environmental factors like toxins and radiation are considered negligible.
- Treatment decisions are risk-stratified, with high-dose Chlorambucil as a first-line option and purine analogs like Fludarabine as second-line therapy for resistant cases.
Impact:
- Understanding the latest diagnostic and therapeutic approaches is crucial for improving patient outcomes in CLL.
- The review highlights the evolving role of hemopoietic stem cell transplantation as a curative option for a subset of patients.
Abstract:
Chronic lymphocytic leukaemia is the most frequent form of malignant hematological diseases in the Western countries, it comprises 30-40% of all the leukaemias and it manifests itself between 60-65 years of age. Clinical features are caused in 93% of the cases by the accumulation and proliferation of immunologically incompetent, anergic, long lived, CD5 positive B-lymphocytes, expressing monoclonal IgM or IgD immunglobulin, in the bone marrow, the peripheral blood, the lymphoid and in other organs. In the etiology genetic basis is highly supposed, whereas affect of toxic agents and radiation exposure can be neglected. The prognosis of patients is variable and is determined by the clinical stage and the proliferative activity of the disease. Treatment is indicated in intermediate and high-risk clinical stages only with signs of disease activation on the basis of individual patient's risk. As first line treatment, Chlorambucil is indicated in high doses. Results achieved by combined chemotherapy are generally not superior compared to high-dose Chlorambucil treatment. For patients who developed resistance to alkilating agents purin analogues are recommended. Out of them the most favorable results had been accumulated with Fludarabine as second line treatment. For minority of the cases hemopoetic stem cell transplantation as the only curative therapeutic measure is being introduced in an increasing number. This review gives an account of the recent advances in the diagnosis and therapy of the disease.