Chemotherapy: Initial management of patients with chemotherapy is currently reserved for rapid lowering of white blood cell counts, reduction of symptoms, and reversal of symptomatic splenomegaly.
Imatinib Mesylate (Gleevec) - competitive inhibition at the adenosine triphosphate (ATP) binding site of the Abl kinase, which leads to inhibition of tyrosine phosphorylation of proteins involved in Bcr/Abl signal transduction induces apoptosis in cells expressing Bcr/Abl. to achieve molecular remission (negative PCR result for the mutational bcr-abl m-RNA). to achieve cytogenetic remission (normal chromosome returns with 0% Ph-positive cells),. to achieve a hematologic remission (normal CBC count and physical examination, ie, no organomegaly),. However, the molecular consequences of these changes appear similar to those resulting from the typical t(9 22). Some patients may have complex translocations (designated as variant translocations) involving three, four, or five chromosomes (usually including chromosomes 9 and 22). The cytogenetic hallmark of CML, found in 90 to 95% of patients, is the t(9 22). Cytogenetic evidence of another Ph-positive clone (double) or clonal evolution (other cytogenetic abnormalities such as trisomy 8, 9, 19, or 21, isochromosome 17, or deletion of Y chromosome). Blast cells can be classified as myeloid, lymphoid, erythroid, or undifferentiated, based on morphologic, cytochemical, and immunologic features. Hyposegmented neutrophils may appear (Pelger-Huet anomaly). is defined as acute leukemia, with blood or marrow blasts >20%. Bone pain and fever, as well as an increase in bone marrow fibrosis, are harbingers of the last phase. Splenomegaly may not be controllable by medications, and anemia can worsen. Bone marrow failure, defined as hemoglobin 15%), promyelocytes ( >30%), basophils ( >20%), and platelet counts less than 100,000 cells/mL unrelated to therapy. Lymphadenopathy and organomegaly - an intermediate prognosis,. Only blood and bone marrow involvement by leukemia but no lymphadenopathy, organomegaly, or signs of bone marrow failure - the best prognosis. Abnormalities in chromosome 13 are also seen. If cytogenetic studies are performed, trisomy 12 is found in 25 to 30% of patients. Bone marrow aspiration and biopsy with flow cytometry. Finding bone marrow infiltration by the same cells >30%. The peripheral blood smear shows many “smudge” or “baske ” cells, nuclear remnants of cells damaged by the physical shear stress of making the blood smear. Increased absolute number of circulating lymphocytes >10*109. chemistry tests to measure major organ function,. Autoimmune hemolytic anemia or/and thrombocytopenia. Localized or generalized lymphadenopathy. Because normal CD5+ B cells are present in the mantle zone (MZ) of lymphoid follicles, B-cell CLL is most likely a malignancy of an MZ-based subpopulation of anergic self-reactive cells devoted to the production of polyreactive natural autoantibodies. B-CLL cells express extremely low levels of surface membrane. B-CLL lymphocytes typically show B-cell surface antigens, as demonstrated by CD19, CD20, CD21, and CD24 monoclonal antibodies. The cells of origin in the majority of patients with CLL are clonal B cells arrested in the B-cell differentiation pathway, intermediate between pre-B cells and mature B cells. A cell becomes committed to T cell differentiation upon migration to the thymus and rearrangement of T cell antigen receptor genes. A cell becomes committed to B cell development when it begins to rearrange its immunoglobulin genes. Low hematocrit and hemoglobin with chronic kidney disease series#
Through the ordered and sequential activation of a series of transcription factors, the cell first becomes committed to the lymphoid lineage and then gives rise to B and T cells. All lymphoid cells are derived from a common hematopoietic progenitor that gives rise to lymphoid, myeloid, erythroid, monocyte, and megakaryocyte lineages.The etiologic factors for typical CLL are unknown. CLL is more common in men than in women and more common in whites than in blacks. In the US more than 17,000 new cases are reported every year. It occurs most frequently in older adults and is exceedingly rare in children.
Chronic lymphoid leukemia (CLL) is the most prevalent form of leukemia in western countries.is a monoclonal disorder characterized by a progressive accumulation of functionally incompetent lymphocytes.
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