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Case 59
Published in Atul B. Mehta, Keith Gomez, Clinical Haematology, 2017
The blood film shows increased numbers of mature lymphoid cells and increased numbers of damaged, or smear, cells. Similar cells are seen in the marrow. These findings suggest chronic lymphocytic leukaemia (CLL). Confirmation is by flow cytometry to demonstrate positivity for the mature B lymphocyte antigens CD19, 20 and 22. The monoclonal nature of the cells is confirmed by demonstrating that the cells have only kappa or lambda light chains (but not both) on their surface. Flow cytometry of the B-cell CLL variants is shown in Table 59.1. Important determinants of prognosis in B-cell CLL are shown in Table 59.2 and in Case 10.
Cardiovascular system
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Chronic lymphocytic leukaemia (CLL)Most common leukaemia in the elderlySymptoms: – fever– discomfort in splenic region– anaemiaSigns: – hepatomegaly– splenomegaly– thrombocytopeniaInvestigations: – blood film analysis (raised lymphocyte count)– immunophenotype (CD20 + CD5 + B cells)Management: – antibiotics (for infection)– purine analogues (fludarabine)Complications of bone-marrow transplant: – graft-versus-host disease (GVHD)
Using blood calprotectin as a measure of blood neutrophils
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2021
Arne Åsberg, Lena Løfblad, Amela Felic, Marthe Wedø Aune, Gunhild Garmo Hov, Unn Merete Fagerli
The correlation between b-calprotectin and b-neutrophils in the 77 patients is shown in Figure 1, which also indicates the total blood leukocyte count. The two patients with a total leukocyte count above 20 × 109/L were both diagnosed with chronic lymphocytic leukemia. B-calprotectin divided by b-neutrophils (b-calprotectin per neutrophil) in those patients were 25 and 27 pg, not different from the other 75 patients, where b-calprotectin per neutrophil ranged from 21 to 50 (median 30) pg, except from one patient with 12 pg b-calprotectin per neutrophil. In the 120 blood donors, the corresponding figures were 22–37 (median 29) pg, statistically not significantly different from the patients (p = .48). The Spearman rank correlation coefficient between b-calprotectin and b-neutrophils was 0.986 (p < .0001) in patients and 0.957 (p < .0001) in blood donors. The corresponding figures for p-calprotectin were 0.435 (p < .0001) in patients and 0.466 (p < .0001) in blood donors, respectively.
What role for AHR activation in IL4I1-mediated immunosuppression ?
Published in OncoImmunology, 2021
Flavia Castellano, Armelle Prevost-Blondel, José L. Cohen, Valérie Molinier-Frenkel
The role of IL4I1 has been characterized in mouse models of transplanted and spontaneous melanoma, both in WT and IL4I1 deficient backgrounds, clearly showing that it facilitates tumor growth by inhibiting the antitumor cytotoxic T-cell response and remodeling the tumor immune microenvironment.9,10 These observations have been recently extended to a model of chronic lymphocytic leukemia.11 In line with this, clinical correlations have been reported between IL4I1 expression by stromal cells and invasion of the sentinel lymph nodes, a higher melanoma stage, and rapid relapse in human primary cutaneous melanomas, in which IL4I1 expression was analyzed by immunohistochemistry.12 Most interestingly, zones in which IL4I1 expression was concentrated were depleted of cytotoxic CD8+ T cells and enriched with regulatory FoxP3+ T cells. Moreover, IL4I1 was overexpressed in melanoma patients with progressive disease under treatment with the anti-PD-1 antibody nivolumab, suggesting a relation between IL4I1 expression and resistance to immune-checkpoint blockade.11
Managing patients with hematological malignancies during COVID-19 pandemic
Published in Expert Review of Hematology, 2020
Certain specific characteristics are specified in the case of Chronic lymphocytic leukemia (CLL). First, it is usually a disease of old individuals with a median age at diagnosis ranging from 65–70 years [24]. Secondly, it is a B cell disorder and the associated hypogammaglobulinemia predisposes for increased risk of recurrent infections. CLL is the most common form of leukemia in the western world, and with the old age and other associated comorbidities, this population is likely to perform worse, however, this needs confirmation. Based on the International Workshop on Chronic Lymphocytic Leukemia (iwCLL), for those CLL patients in whom treatment is indicated, it is advisable to avoid intense regimens like fludarabine, cyclophosphamide, and rituximab (FCR) due to risk of severe myelosuppression [25]. Similarly, the monoclonal antibodies, such as rituximab and obinutuzumab, may lead to B-cell depletion, reduce the humoral immunity further, and hence are recommended to avoid. Several oral target agents are now available, such as ibrutinib (BTK inhibitor), acalabrutinib (a second-generation BTK inhibitor), and venetoclax for use in CLL which can be used either alone or in combination depending upon various patient or disease-related risk factors.