Internal Medicine

0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

336 Chronic Lymphocytic Leukemia Chronic Myelogenous Leukemia

complications and prognosis

Complications

■Pancytopenia

■Opportunistic infections

■Auto-immune hemolytic anemia

Prognosis

■Stage: median survival for stage

➣Stage 0: 12+yrs

➣Stage I: 8.5 yrs

➣Stage III: 1.5 yrs

➣Stage IV: 1.5 yrs

■Bone marrow histology: diffuse pattern of lymphoid infiltration has

worse prognosis

■Lymphocyte doubling time (LDT): a rapid LDT of <12 months has

poor outcome

■CD-38 expression on the CLL B lymphocytes is associated with worse

prognosis

Chronic Myelogenous Leukemia.........................

ALAN M. GEWIRTZ, MD

history & physical

Epidemiology

■15% of all leukemias; incidence 1–2 cases per l00,000 population

■A disease predominantly affecting middle-aged individuals (median

age 45–55 yrs old) but all age groups, including children, represen-

ted

■Increased incidence in survivors of atomic bomb explosions but oth-

erwise, no definitive link to environmental or infectious causation

Signs & Symptoms

■Fatigue, anorexia, night sweats, weight loss, abdominal fullness, easy

bruising and bleeding; infections unusual

■40–50% of cases asymptomatic, and picked up by routine CBC

■splenomegaly, of variable degree, most common finding – 75% of

patients