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Chronic Leukemia

Chronic Blood Cancer


Presentation

  • A key challenge presented by intratumoral heterogeneity is its capacity to fuel clonal evolution and the generation of therapy resistant subpopulations.[bloodjournal.org]
  • Thus, CLL may present in individuals with a long history of having high-count CLL/SLL MBL.[en.wikipedia.org]
  • Assessment of reticulocyte count, ferritin, iron saturation, vitamin B 12, and folate and correction of nutritional deficiencies if present is recommended for patients with grade 3/4 anemia.[jnccn.org]
Fatigue
  • […] myeloid leukemia USMLE Step 2 style questions 2 questions Chronic lymphoid leukemia USMLE Step 1 style questions 2 questions Chronic lymphoid leukemia USMLE Step 2 style questions 2 questions Preview A 71-year-old man comes to the clinic because of fatigue[osmosis.org]
  • Imatinib: Chronic fatigue (mostly correlated with musculoskeletal pain and muscular cramps) is a major factor reducing quality of life. 47 Hypophosphatemia and decrease in bone mineral density has been noted in a small group of patients, suggesting that[jnccn.org]
Malaise
  • […] leukemia USMLE Step 2 style questions 2 questions Chronic lymphoid leukemia USMLE Step 1 style questions 2 questions Chronic lymphoid leukemia USMLE Step 2 style questions 2 questions Preview A 71-year-old man comes to the clinic because of fatigue and malaise[osmosis.org]
Pleural Effusion
  • Close monitoring and timely intervention are necessary for patients at risk of developing pleural effusions.[jnccn.org]
Nausea
  • Adverse Events of First-Line TKI Therapy in CP-CML Nilotinib: In the ENESTnd study, nonhematologic adverse events such as nausea, diarrhea, vomiting, muscle spasm, and peripheral edema of any grade were higher for patients receiving imatinib. 41 Conversely[jnccn.org]
Vomiting
  • Adverse Events of First-Line TKI Therapy in CP-CML Nilotinib: In the ENESTnd study, nonhematologic adverse events such as nausea, diarrhea, vomiting, muscle spasm, and peripheral edema of any grade were higher for patients receiving imatinib. 41 Conversely[jnccn.org]
Diarrhea
  • Bosutinib: In the BFORE study, diarrhea, increased alanine aminotransferase (ALT), and aspartate aminotransferase (AST) were more common with bosutinib, whereas muscle spasms and peripheral edema were more common with imatinib.[jnccn.org]
Heart Disease
  • Dasatinib or bosutinib may be preferred in patients with a history of arrhythmias, heart disease, pancreatitis, or hyperglycemia. Adverse events of first-line TKI therapy in patients with CP-CML reported in phase III randomized Table 3.[jnccn.org]
Hypertension
  • Reversible pulmonary arterial hypertension has been reported as a rare but serious side effect of dasatinib. 54, 55 In the DASISION study, pulmonary hypertension was reported in 5% of patients compared with 0.4% of patients treated with imatinib. 40 Evaluation[jnccn.org]
Thrombosis
  • Myeloid growth factor support can be used in combination with TKI therapy for the management of neutropenia. 62, 63 The use of erythropoiesis-stimulating agents (ESAs) did not impact survival or cytogenetic response rate, but was associated with a higher thrombosis[jnccn.org]
Musculoskeletal Pain
  • Imatinib: Chronic fatigue (mostly correlated with musculoskeletal pain and muscular cramps) is a major factor reducing quality of life. 47 Hypophosphatemia and decrease in bone mineral density has been noted in a small group of patients, suggesting that[jnccn.org]
Pruritus
  • Resumption of TKI therapy immediately after recurrence results in the achievement of undetectable disease in almost all patients. 149 – 160 TKI withdrawal syndrome (aggravation or new development of musculoskeletal pain and/or pruritus after discontinuation[jnccn.org]
Responsiveness Decreasing
  • (decrease in the amount of BCR-ABL1 chimeric mRNA using qPCR).[jnccn.org]

Workup

  • Diagnosis and Workup Initial evaluation should consist of a history and physical exam, including palpation of spleen, Download Figure NCCN Clinical Practice Guidelines in Oncology : Chronic Myeloid Leukemia, Version 1.2019 Version 1.2019, 08-01-18 2018[jnccn.org]
Cytopenia
  • Do regulatory T cells have a role in disease progression and autoimmune cytopenias of chronic lymphocytic leukemia? (Abstract) Blood. 2011; 118 :3864. [ Google Scholar ] 22. Hallek M, Cheson BD, Catovsky D, et al.[ncbi.nlm.nih.gov]
  • However, no hepatotoxicity-related fatalities occurred during the study. 42 Management of Hematologic Toxicities of TKI Therapy: Cytopenias (anemia, neutropenia, and thrombocytopenia) should be managed with transient interruptions of TKI therapy and dose[jnccn.org]
Pleural Effusion
  • Close monitoring and timely intervention are necessary for patients at risk of developing pleural effusions.[jnccn.org]

Treatment

  • Treatment [ edit ] CLL treatment focuses on controlling the disease and its symptoms rather than on an outright cure.[en.wikipedia.org]
  • Alternate treatment options should be considered as described subsequently.[jnccn.org]
  • Rituximab in combination with high dose methylprednisolone for the treatment of fludarabine refractory high risk chronic lymphocytic leukemia.[ncbi.nlm.nih.gov]
  • For more than a decade, “watch and wait” has been the standard approach for patients without symptomatic disease, with frontline chemotherapy-based therapy as the conventional choice if treatment is required.[bloodjournal.org]
  • Chronic leukemia 17 flashcards Preview Treatment for chronic lymphocytic leukemia include. Questions on Chronic leukemia This is an Osmosis Prime feature Test your knowledge and prepare for the boards with these in-depth practice questions.[osmosis.org]

Prognosis

  • The distinction is important as the prognosis and therapy differ from CLL.[en.wikipedia.org]
  • Previous work suggested that the overall prognosis of Ph-negative CML with clonal evolution is good and is dependent on response to imatinib therapy. 21 Recently, however, the presence of chromosome abnormalities other than loss of Y chromosome has been[jnccn.org]
  • ZAP-70 expression and prognosis in chronic lymphocytic leukaemia. Lancet. 2004; 363 :105–111. doi: 10.1016/S0140-6736(03)15260-9. [ PubMed ] [ CrossRef ] [ Google Scholar ] 20. Crespo M, Bosch F, Villamor N, et al.[ncbi.nlm.nih.gov]
  • Incorporating evolutionary concepts into schema for CLL prognosis, monitoring, and treatment The tracking of intratumoral heterogeneity over time can provide critical information on clonal dynamics, which could impact the management of patients.[bloodjournal.org]

Etiology

  • […] and UK NCRN CLL201 and CLL202. 36 DCFI, Dana-Farber Cancer Institute; ERIC, European Research Initiative on CLL; GCFLLC/MW-GOELAMS, French CLL Intergroup; GCLLSG, German CLL Study Group; MLL, Munich Leukemia Laboratory; SCALE, Scandinavian Lymphoma Etiology[bloodjournal.org]

Epidemiology

  • […] subtypes have a median survival of 6–8 years, while others have a median survival of 22 years (which is a normal lifespan for older patients). [ citation needed ] Telomere length has been suggested to be a valuable prognostic indicator of survival. [53] Epidemiology[en.wikipedia.org]
Sex distribution
Age distribution

Prevention

  • Thus, as an “adaptive therapy” strategy, 90 a key goal would be to maintain subclonal relationships such that the emergence of the more resistant clones is prevented.[bloodjournal.org]
  • […] received TKI therapy for 3 years with either a stable MMR or MR4.0 for 12 months. 92 Response Milestones after First-Line TKI Therapy The goal of TKI therapy is to achieve a CCyR ( 1% BCR-ABL1 IS ) within 12 months after first-line TKI therapy and to prevent[jnccn.org]

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