CHRONIC LYMPHOCYTIC LEUKAEMIA (cll) Case Study
Jacob is a 74-year-old Caucasian man who in 2014 had developed macrocytic anaemia and had been offered a further evaluation of his condition in 2015.
The patient was otherwise asymptomatic and his past medical history was unremarkable. He was not on any regular medication and had no history of exposure to ionizing radiation or toxic chemicals. The physical examination was not remarkable and had no palpable lymphadenopathy nor hepatosplenomegaly.
Laboratory studies showed a leukocyte count of 4.710
9
/L with 85% lymphocytes, 12% neutrophils, 3% monocytes, haemoglobin of 120 g/L, haematocrit of 0.36, MCV of 104 fl, MCHC of 35 picograms and platelet count of 168 10
9
/L. The coagulation profile was normal, and a detailed metabolic panel and viral serology were unremarkable.
A subsequent peripheral blood smear showed a monomorphic population of small lymphocytes counting for 80% of cells, 5% monocytes, and 15% segmented neutrophils. Flow cytometry of peripheral blood revealed a population of cells with low side scatter which expressed CD5, CD19, CD23 and CD20 in addition to kappa light chain. The immunophenotype was consistent with chronic lymphocytic leukaemia (CLL). The stage of the disease was identified as Rai 1.
For the prognostication further analysis has been performed. ZAP70 expression was positiveand he had unmutated
IGHV
genes.Fluorescence
in situ
hybridization (FISH) was done which was not compulsory, and Jacob had del(17p).
Meanwhile Jacob
reported symptoms of weight loss, fatigue, and pain in the upper left portion of his abdomen. Moderate axillary lymphadenopathy and splenomegaly has been detected. Otherwise, the patient appeared well overall and continued to exercise
.
Jacobwas prescribed to betreated with Ibrutinib 420 mg daily. After 18 months, he achieved complete remission of his disease and resolution of his symptoms. Howeverin 2018 he had developed atrial fibrillation and despite cardiology interventions could not restart Ibrutinib. During routine follow up, Jacob reported increasing fatigue, cervical lymphadenopathy, spleen, palpable 8 cm below the costal margin.
Since then Jacob was started on Venetoxlac.
Write a reflective commentary based on the breast cancer case study above.
You should address the following topics:
1)
Give outline of the disease incidence in various populations.
2)
Discuss cellular and molecular background for CLL.
1024198
3)
Given the set of prognostic indicators, predict the likely patient prognosis.
4)
Describe targeted therapy for this patient, and possible alternative treatment schemes.
5)
Consider biomarker tests that might be useful for monitoring the disease progression in this patient after treatment.
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