Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- dispneia e fadiga
- linfadenopatia
- esplenomegalia
- hepatomegalia
Outros fatores diagnósticos
- presença de fatores de risco
- sintomas B
- infecções recorrentes
- epistaxe
- palidez
- petéquias
Fatores de risco
- idade superior a 60 anos
- sexo masculino
- etnia branca
- história familiar de leucemia linfoide crônica (LLC)
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- Hemograma completo com diferencial
- citometria de fluxo
- esfregaço de sangue periférico
Investigações a serem consideradas
- microglobulina beta-2 sérica
- hibridização in situ fluorescente (FISH)
- Testes moleculares genéticos
- teste de antiglobulina direto (TAD)
- imunoglobulinas quantitativas séricas
- biópsia de linfonodos
- aspirado de medula óssea e biópsia por trefina
- TC/PET com fluordesoxiglucose (FDG)-CT
Algoritmo de tratamento
fase inicial assintomática (Binet A e B; Rai 0-II)
estádio avançado (Binet C; Rai III-IV) ou com indicações para tratamento (por exemplo, sintomas)
doença recidivante ou refratária
Colaboradores
Autores
Jacqueline C. Barrientos, MD, MS
Associate Professor
Department of Medicine
Zucker School of Medicine at Hofstra/Northwell
CLL Research & Treatment Program
Northwell Health Cancer Institute
Lake Success
NY
Declarações
JCB has been a consultant for Beigene, Abbvie, and AstraZeneca; received honoraria from Janssen; and received research funding from Oncternal, VelosBio, and Pharmacyclics.
Joanna M. Rhodes, MD, MSCE
Assistant Professor
Department of Medicine
Zucker School of Medicine at Hofstra/Northwell
CLL Research and Treatment Program
Northwell Health Cancer Institute
Lake Success
NY
Declarações
JMR has received fees for consulting for Abbvie, Genentech, Pharmacyclics, Beigene, AstraZeneca, Morphosys, Epizyme, ADC Therapeutic, TG Therapeutics, Versatem, SeaGen, and Jannsen. JMR’s institution has received research support from Oncternal Pharmaceutics, Pharmacyclics, Acerta, Loxo Oncology, Velosbios, Abbvie, and AstraZeneca.
Agradecimentos
Dr Jacqueline C. Barrientos and Dr Joanna M. Rhodes would like to gratefully acknowledge Dr Vidhya Murthy, Dr Shankaranarayana Paneesha, and Dr Robert Chen, previous contributors to this topic.
Declarações
VM has received a consultancy fee from Janssen, and a grant from Takeda for the ASH Annual Meeting 2014. SP has received consultancy and speaker fees from Janssen, Gilead, AbbVie, Bristol-Myers Squibb, and Takeda. RC declares that he has no competing interests.
Revisores
Alessandra Ferrajoli, MD
Associate Medical Director, Professor
Department of Leukemia Center
The University of Texas MD Anderson Cancer Center
Houston
TX
Declarações
AF declares that she has no competing interests.
Farrukh Awan, MD
Professor of Medicine
Department of Internal Medicine
UT Southwestern Medical Center
Dallas
TX
Declarações
FA declares that he has no competing interests.
Paolo F. Caimi, MD
Associate Professor
Department of Medicine
Case Western Reserve University
Case Comprehensive Cancer Center
Cleveland
OH
Declarações
PFC has received honoraria from Celgene for participation in a speaker bureau, and from Kite Pharma for participation in an advisory board.
Daniel Catovsky, MD, FRCP, FRCPath, DSc, FMedSc
Consultant Haemato-oncologist
Section of Haemato-Oncology
The Institute of Cancer Research
Sutton
UK
Declarações
Unfortunately, we have since been made aware that DC is deceased.
Referências
Principais artigos
Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018 Jun 21;131(25):2745-60.Texto completo Resumo
Walewska R, Parry-Jones N, Eyre TA, et al. Guideline for the treatment of chronic lymphocytic leukaemia. Br J Haematol. 2022 Jun;197(5):544-57.Texto completo Resumo
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma [internet publication].Texto completo
Eichhorst B, Robak T, Montserrat E, et al; ESMO Guidelines Committee. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021 Jan;32(1):23-33.Texto completo Resumo
Hallek M, Al-Sawaf O. Chronic lymphocytic leukemia: 2022 update on diagnostic and therapeutic procedures. Am J Hematol. 2021 Dec 1;96(12):1679-705.Texto completo Resumo
Artigos de referência
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Diagnósticos diferenciais
- Fase leucêmica do linfoma
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- Chronic lymphocytic leukemia/small lymphocytic lymphoma
- Hematopoietic cell transplantation (HCT)
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