New Developments in Chronic Lymphocytic Leukaemia Diagnosis

Abstract

Abstractchronic lymphocytic leukaemia (cll) is the most prevalent leukaemia in the developed world, with a remarkable racial and sex diversity.The diagnosis of cll is based on the presence in blood of more than 5,000 monoclonal B cells/µl, with a distinctive immunophenotype (cd5+, Smig dim , cd20 dim , cd19, cd23), which persists for more than 3 months. Newer monoclonal antibodies, such as anti-cd43, anti-cd200 or anti-RoR1, may provide further information in differentiating cll from other chronic lymphoproliferative disorders. cll lacks a specific genetic signature regarding chromosomic aberrations, but in cases of uncertain diagnosis molecular genetics including fluorescent in situ hybridisation may be useful. Next-generation sequencing techniques are unfolding the molecular heterogeneity of cll. in Europe, the incidence rate is similar (4.9 cases/year), with a similar sex distribution (5.9 for males and 4.0 for females). 5 The incidence of cll dramatically increases with age, reaching >20 cases/year in individuals older than 70, and even >30 cases/year in patients aged 80 or older.on the contrary, cll is infrequent in persons under the age of 40 (0.2 cases/year). 4 one of the most notorious epidemiological characteristics of cll is its racial diversity. Within the uS, the incidence rate is highest in caucasian males (6.2 cases/year) and females (3.2 cases/year) compared with african americans (4.3 and 2.0 cases/year for males and females, respectively), while asian americans and Pacific islanders had the lowest incidence (1.3 and 0.7 cases/year for males and females, respectively). 4incidence rates are even lower in the Far East, and countries such as Japan have an age-adjusted incidence of 0.48 cases/year, which is even lower than that of mantle-cell lymphoma (Mcl) in that region. 6Furthermore, the clinical outcome of patients with cll is also different across various ethnic groups. in the uS, african american patients with cll present at a younger age and with more frequent advanced disease, extranodal involvement and B symptoms compared with caucasian patients. consequently, african american patients had a significantly shorter event-free and overall survival, an effect that was found to be independent from other prognostic factors in a multivariable analysis. 7 By contrast, in a recent series or Japanese patients, most cases had favourable prognostic markers and an excellent clinical outcome. 8 it is important to note, however, that rather than diversity in the characteristics of the disease, these differences could reflect disparities in access to medical care. 7 DiagnosisThe hallmark of the disease is an increased white blood cell count with a high percentage of small, mature-looking lymphocytes. in patients diagnosed on routine analysis, anaemia is found in less than 10 % of the patients. importantly, anaemia is not always due to the infiltration of the bone marrow by the disease; other causes such as autoimmunity, iron, folic acid or vitamin B12 deficiency may account for the presence of anaemia a...

Clinical Aspects, Immunophenotypic Analysis and Survival Rate of Chronic Lymphocytic Leukaemia Patients in Erbil City, Iraq

“…2,15,16 However, in developed countries, only 10-20% of patients present at an advanced stage. 17 These findings may indicate that routine CBC analysis is less frequently performed in developing countries or that hospitals in this region lack proper evaluation and management protocols or experience delays in the referral of patients with incidental lymphocytosis. It is also possible that there is a difference in the biology of the disease (e.g.…”