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1、ChronicLymphocyticLeuk【关键词】CCL,#8226;,Chronic,lymphocytic,leukemia,#8226;,Rituximab,#8226;,ZAP70 LEARNINGOBJECTIVES Afterpletingthiscourse,thereaderarkersforCLL,includingZAP70expression,IgVHrearrangements,andCD38expression. DescribethelatestchemotherapyregimensforCLL,i
2、ncludingbinationscontainingnucleosideanaloguesandmonoclonalantibodies. DescribeappropriateindicationsforinitiationoftreatmentforCLL. ABSTRACT Chroniclymphocyticleukemia(CLL)isalophoidmalignancybutmayhavemoreheterogeneitythanpreviouslythought.Manycasesrequirenotreatment
3、atallbecauseofanindolentcourse,ptomaticordevelopsignsofrapidprogression.Treatmentisusuallynoncurativeandisdirectedatreducingthesymptoms.Somemolecularriskfeaturesmayhelpdelineate,atinitialdiagnosis,oreaggressivecourse.Neentregimensincorporatingpurinenucleosideanaloguesandm
4、onoclonalantibodieshaveincreasedtherateofmolecularpleteremissions,ayleadtobettersurvivaltimes.Reducedintensityallogeneictransplantconditioningregimenshavemadethepotentiallycurativemodalitymoreentshavesignificantrisksforinfectiousplications,ustbecarefullyentalgorithmisdisc
5、ussed. DIAGNOSISANDSTAGING Chroniclymphocyticleukemia(CLL)ispredominantlyadiseaseofolderindividuals;mostpatientsareolderthan50atthetimeofinitialdiagnosis[1,2].Furthermore,thediseaseoftenhassloanyofthesepatientsultimatelysuccumbtoothermedicalproblemsratherthantoCLL.Add
6、itionally,amonoclonallymphocytosisispresentinupto4%ofelderlyindividuals,andmostofthesecasesdonoteverprogresstomeetthediagnosticcriteriaofCLL[3].CLLmaypresentasalymphnodebaseddisease,calledsmalllymphocyticlymphoma(SLL),andthetreatmentisgenerallythesameasforCLL.Hoayalsopres
7、entinupto5%ofpatientsationinthelymphnodes,requiringmoreaggressivetreatmentphomaregimensandostmonpresentingsymptominCLLislymphnodesallernumbersofpatientsreport"B"symptoms(fever,ptomatic.Themostmonphysicalfindingsphadenopathy(87%),splenomegaly(54%),andhepatomegaly(14%).Occa
8、sionally,laboratoryabnormalitiesareseeninnebs-positiveautoimmunehemolyticanemia.Tenpercentofpati
