TAILIEUCHUNG - Chapter 105. Malignancies of Lymphoid Cells (Part 15)

B Cell Chronic Lymphoid Leukemia/Small Lymphocytic Lymphoma: Treatment Patients whose presentation is typical B cell CLL with no manifestations of the disease other than bone marrow involvement and lymphocytosis (., Rai stage O and Binet stage A; Table 105-7) can be followed without specific therapy for their malignancy. These patients have a median survival 10 years, and some will never require therapy for this disorder. If the patient has an adequate number of circulating normal blood cells and is asymptomatic, many physicians would not initiate therapy for patients in the intermediate stage of the disease manifested by lymphadenopathy and/or. | Chapter 105. Malignancies of Lymphoid Cells Part 15 B Cell Chronic Lymphoid Leukemia Small Lymphocytic Lymphoma Treatment Patients whose presentation is typical B cell CLL with no manifestations of the disease other than bone marrow involvement and lymphocytosis . Rai stage O and Binet stage A Table 105-7 can be followed without specific therapy for their malignancy. These patients have a median survival 10 years and some will never require therapy for this disorder. If the patient has an adequate number of circulating normal blood cells and is asymptomatic many physicians would not initiate therapy for patients in the intermediate stage of the disease manifested by lymphadenopathy and or hepatosplenomegaly. However the median survival for these patients is 7 years and most will require treatment in the first few years of follow-up. Patients who present with bone marrow failure . Rai stage III or IV or Binet stage C will require initial therapy in almost all cases. These patients have a serious disorder with a median survival of only years. It must be remembered that immune manifestations of typical B cell CLL should be managed independently of specific antileukemia therapy. For example glucocorticoid therapy for autoimmune cytopenias and y globulin replacement for patients with hypogammaglobulinemia should be used whether or not antileukemia therapy is given. Patients who present primarily with lymphoma and have a low IPI score have a 5-year survival of 75 but those with a high IPI score have a 5-year survival of 40 and are more likely to require early therapy. The most common treatments for patients with typical B cell CLL small lymphocytic lymphoma have been chlorambucil or fludarabine alone or in combination. Chlorambucil can be administered orally with few immediate side effects while fludarabine is administered IV and is associated with significant immune suppression. However fludarabine is by far the more active agent and is the only drug .

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