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Printable Handouts
Navigable Slide Index
- Introduction
- Overview
- Chronic lymphocytic leukemia (CLL)
- Diagnostic criteria (iwCLL 2018)
- Differential diagnosis
- What about MBL?
- MBL management
- CLL vs. SLL vs. MBL
- Natural history of CLL
- CLL presentation
- Rai staging (1)
- Rai staging (2)
- Rai stage is associated with survival
- Cytogenetics & fluorescence in situ hybridization (FISH)
- FISH testing & hierarchical risk categories (1)
- FISH testing & hierarchical risk categories (2)
- Complex karyotype
- Immune globulin heavy chain (IGHV) mutational status
- Survival by IGHVs mutational status
- The CLL-IPI score & risk groups
- CLL-IPI predicts survival
- CLL-IPI predicts time to first treatment
- When should testing be done?
- Rationale for observation
- Randomized to chlorambucil vs. observation
- Meta-analysis of randomized trials of observation
- Treatment indications: iWCLL 2018 guidelines
- Recommended assessments
- How to approach selecting initial treatment
- Previously untreated CLL
- The development of chemoimmunotherapy
- Long-term FCR data
- Major mechanisms of action of current CLL therapies
- The era of targeted agents
- NCCN recommendations
- Chemoimmunotherapy vs. ibrutinib
- Outstanding efficacy
- Ibrutinib regimens have improved PFS and OS
- FCR vs. IR in IGHV mutated patients
- ELEVATE-TN: randomized phase 3
- ELEVATE-TN: frontline acalabrutinib ± obinutuzumab vs. chlorambucil + obinutuzumab
- SEQUOIA: frontline zanubrutinib vs. bendamustine/rituximab
- BTK inhibitor-based treatment
- The BCL2 inhibitor venetoclax
- CLL14: first-line obinutuzumab + venetoclax or chlorambucil (time limited)
- CLL14: MRD negativity
- CLL13 – VO in fit patients
- OS after VO according to MRD status
- Comparison: first line treatment options (1)
- Rationale for combining ibrutinib and venetoclax
- GLOW Trial: 4-year follow-up from a multicenter, open-label, randomized, phase 3 trial
- Phase III UK NCRI study-primary end-point
- Comparison: first line treatment options (2)
- Choosing between frontline agents
- Making progress in treatments for patients with CLL
- Health implications of CLL (treated or not)
- Thank you
Topics Covered
- Chronic lymphocytic leukemia (CLL)
- Diagnostic criteria of CLL
- Staging & risk stratification
- Rationale for observation
- Treatment indications
- Approach to selecting initial treatment
- Regimens/complications
- Areas of ongoing research
Talk Citation
Bhat, S. (2024, October 31). Chronic leukemia: an overview [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved December 9, 2024, from https://doi.org/10.69645/DTTK9496.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. Seema Bhat has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
A selection of talks on Haematology
Transcript
Please wait while the transcript is being prepared...
0:00
Hello. I'm Dr Seema Ali Bhat.
I am an Associate Professor
in the division of Hematology,
Department of Internal Medicine
at the Ohio State University.
I'll be talking about "Chronic
Lymphocytic Leukemia" today.
0:17
In this talk, we will go
over diagnostic criteria,
staging and risk stratification,
rationale for observation
in asymptomatic patients,
treatment indications in
symptomatic patients,
approach to selecting
initial treatment,
regimens and their
complications,
and areas of ongoing research.
0:41
Chronic lymphocytic leukemia is
the most prevalent adult
leukemia in the United States.
This is a disease of
older patients with
median age at diagnosis
of around 72 years.
There's slight male predominance
and is more common in whites.
This disease is fairly rare
in the Asian population.
Annually there are about 4,500
deaths due to chronic
lymphocytic leukemia.
However over the
last two decades,
there has been an increase in
the overall survival of patients
with chronic
lymphocytic leukemia.
This is due to
improved therapies
that are available
currently as well as due to
an increase in the length time
bias that we see nowadays
due to the patients
getting routine blood work
done which detects CLL
at an early stage.
1:33
By definition, chronic
lymphocytic leukemia
is a clonal B-cell malignancy.
There's accumulation of
immunologically incompetent
mature appearing
lymphocytes in the blood,
bone marrow, lymph
nodes, and spleen.
By definition, there
has to be presence of
5,000 or more clonal
B-cells in the blood.
These have to be persistent for
more than three months
and clonality is
confirmed by light
chain restriction
either Kappa or Lambda
light chain restriction.
By immunophenotype, these cells
express B- cell antigens,
for example, CD19,
CD20, and CD23.
They also express B-cell
antigen CD5, which is unique.
There is low to dim surface
immunoglobulin expression as
well as CD20 expression
and CD79 B expression.
On smear, you will see
small mature appearing
lymphocytes and you will
also see smudge cells which
are characteristic of CLL.
There are various
diseases that could be in