Transcription
Hey, guys. It's Medicosus Perfectionelos. Welcome to my channel. In the previous video, we have discussed chronic lymphocytic leukemia. Today, let's talk about how to diagnose and treat CLL.
Diagnosis of CLL is not that hard. Believe it or not, bone marrow biopsy is not needed. Why? Because we have lot of ways to diagnose it pretty accurately. So on CBC, you will find lymphocytosis and maybe high reticulocyte count.
Why is that? Because as you know chronic lymphocytic leukemia can lead to warm autoimmune hemolytic anemia. On peripheral smear, the famous smudge cells. On flow cytometry, c d five positive, c d twenty three positive, as well as some b cell markers such as c d nineteen positive, c d twenty positive, etcetera. C l l, again, warm autoimmune hemolytic anemia, will lead to high and a positive Coombs test.
Is it the direct Coombs test or the indirect Coombs test? Let me know in the comments. Now, we are done with the diagnosis, so let's treat. Treatment of c l l, we focus on controlling the disease rather than curing. Early stage c l l, no treatment.
Why is that? Because there is no increased survival benefit. If there are symptoms, if the patient is high risk according to the ray staging system as we have discussed in the previous video, or if there is evidence for bone marrow failure, please give chemotherapy, usually a combination. This combination is just great. It's called f c r, f for fludarabine, c for cyclophosphamide, and r for rituximab.
This combination is big deal. You can use alkylating agents such as chloramucil, bendamustin, or cyclophosphamide. If you have bone marrow failure and autoimmune cytopenia, give steroids. Steroids is very good for any autoimmune problem, generally speaking. For lymphadenopathy, you can use radiation.
Radiation is used if the problem is local, but if it's a systemic problem, of course, we need chemotherapy. So removing or destroying this large lymph node by radiation is called debulking. If you have splenomegaly, you can do splenectomy. Stem cell transplant, of course, is the last resort. There is a drug called alemtuzumab is a monoclonal antibody against c d fifty two.
C l l can have c d fifty two positive. That's why alemtuzumab can be beneficial, but again, it's a last resort. That's it for today. Thank you so much for watching. I'll see you in the next video.
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