CLU represents the end of the leukemia spectrum where the classification merges with that of non Hodgkin's lymphoma. CLLis a neoplastic proliferation of the same cell type as lymphcyticlym-phoma the differntiating feature being the extent of bone marrow infiltration. The symptoms are as follows:
1) maybe asymptomatic for some time
2) painless lymphadepathy
3) symptoms of anemia
4) recurrent infections may also occur
5) fever, sweats and weight loss are the common systematic manifestations.
The signs are peripheral lympadenopathy, spenomegallt and hepatomegally may also occur but is usually mild.
Because CLL has a long indolent cause, in most patients treatment is only considered when symtomatic. There is usually a good response to gentle oral chemotherapy using chlorambucil or cyclophosphamide which can often be discontinued after several months until either the white blood count rises excessively or other local symptoms from enlarged nodes or spenomegally arise. Steroids may also be used and are of value when the disease becomes refractory to alkylating agents but there is no evidence that adding them to chlorambucil or cuclophosphamide in the early management of the disease is of value.
Other combinations have also included vincristine or vinblastine but again no significant advantage over single agent therapy has emerged. Low dose radiation will result in rapid shrinkage of enlarged node masses or spenomegally.
BE AWARE, doses as low as 20 or 30 Gy over two to three weeks are usually sufficient and associated with little or no morbidity. There are no evidence that high dose intensive treatment produces better results than more gentle therapy and bone marrow transplantation has no established role in CLL
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