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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
