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Posted by on Feb 25, 2019 in Leukemia | 0 comments

In a nutshell

This study was a review of the most recent guidelines of diagnosis and treatment of chronic lymphocytic leukemia (CLL) that has transformed into aggressive lymphoma.

Some background

Chronic lymphocytic leukemia is a cancer of the bone marrow and immune system. Over time, it may develop into a cancer of the immune tissues called a lymphoma (known as Richter's transformation). This can worsen prognosis. It is essential to develop clear guidelines for the diagnosis and treatment of this type of lymphoma.

Methods & findings

Evidence for the diagnosis and treatment of lymphoma that transformed from CLL was reviewed.

Taking a history and a physical exam are essentials to the diagnosis. Doctors should also take symptoms and quality of life into account. A number of blood tests measuring LDH and uric acid are also essential. Patients should all have a whole body PET scan or chest/abdomen/pelvis CT scan.

Removal of an immune gland and examining it under a microscope (lymph node biopsy) is the first-line test for diagnosis of changing tissues. When this is not possible, a sample of tissue (core biopsy) is taken and collection of cells through a thin needle (fine needle aspiration) may be acceptable. 

Patients diagnosed with a Richter's transformation should be treated with strong chemotherapy and rituximab (Rituxan). Patients may also be enrolled in a clinical trial to try new drugs. If chemotherapy is effective, patients may go on to have a bone marrow transplant.

Targeted therapies such as nivolumab (Opdivo) and pembrolizumab (Keytruda) with or without ibrutinib (Imbruvica) are also treatment options for patients with CLL and abnormal genes who do not respond to chemotherapy.

The bottom line

The study reviewed the diagnosis and management of CLL transformation into aggressive lymphoma.

Published By :

Journal of the National Comprehensive Cancer Network

Date :

Jan 01, 2019

Original Title :

NCCN Guidelines Insights: Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma, Version 2.2019.

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