Clinical Care Options inPractice chapter on CLL, authored by Jacqueline Barrientos, MD and Kanti Rai, MD, was updated earlier this month (8th August 2016). Key additions include:
* Availability of an online decision aid for CLL
* Updated guidance on the expanded use of ibrutinib in frontline treatment of CLL
* New indication and updated guidance on the use of ofatumumab as extended therapy for patients with relapsed or refractory CLL
* New approval of venetoclax in relapsed CLL with del(17p)
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This resource is regularly updated and references are liberally provided. A few quotes with my emphasis in bold:
Chronic lymphocytic leukemia is the most prevalent adult leukemia in the Western world.
For the most part, CLL is a disease of the elderly, with a median age of 71 years at diagnosis. It is not uncommon, however, for patients to be diagnosed at an earlier age due to the frequent assessment of blood counts and the aggressive workup of mildly elevated lymphocyte counts. In the period between 2006-2010, 30% of CLL cases seen in the United States were diagnosed in persons aged between 45 and 64 years.
The clinical course and presentation of CLL is highly variable and can range from indolent in some patients to extremely aggressive in others.
CLL is more common in males, with a ratio of males to females of approximately 1.5 to 1.0. CLL is more common in Europe, Australia, and North America than in Asia, Africa, or other less developed countries. These differences are believed to be because of genetic—rather than environmental—factors. Regarding environmental causes, sustained exposure to certain agricultural chemicals may be associated with CLL. Evidence also suggests that Vietnam veterans exposed to Agent Orange are at an increased risk.
Essential workup at the time of diagnosis includes obtaining a complete blood count with differential and a complete metabolic panel. A bone marrow biopsy is not required at the time of diagnosis, but it may yield valuable information about the extent of the bone marrow involvement prior to initiating myelosuppressive therapies.
Although retrospective analyses have offered conflicting results with regard to the prognostic value of CT scans in CLL, CT imaging may be useful for following and monitoring disease progression in patients without peripheral adenopathy. Nevertheless, the staging of CLL does not generally require CT scans but relies on physical examination and blood counts. Enlarged lymph nodes, if detected by CT scan only, do not change the initial clinical staging. Positron-emission tomography scans do not provide useful information in the management of patients with CLL unless there is a concern for Richter’s transformation, where these studies can assist in directing nodal biopsy of the area with the most metabolic activity.