Talk:B-cell chronic lymphocytic leukemia

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No longer T-cell?[edit]

What's the authority for saying that "so-called" T-cell CLLs are a separate disease group (and not a subset of CLL)? Who recognizes it?

eMedicine still considers T-cell CLL as CLL as of October 2008. eMedicine Chronic Lymphocytic Leukemia Approximately 2-5% of patients with chronic lymphocytic leukemia (chronic lymphoid leukemia, CLL) exhibit a T-cell phenotype.

Is this a consensus or is this still under debate? Is it something that the broad oncology community agrees on, or is there a different perspective among sub-specialties or disciplines? How do you reconcile this with the eMedicine authors? Nbauman (talk) 18:43, 3 February 2009 (UTC)

It is the consensus of the National Institutes of Health and the World Health Organization's ICD-O. Please note the difference between Leukemia, T Cell, Chronic at the US National Library of Medicine Medical Subject Headings (MeSH) (the 2007 version) and Leukemia, T Cell, Chronic at the US National Library of Medicine Medical Subject Headings (MeSH) (the 2009 version). Per the latter link, T-cell prolymphocytic leukemia is "A lymphoid leukemia characterized by a profound LYMPHOCYTOSIS with or without LYMPHADENOPATHY, hepatosplenomegaly, frequently rapid progression, and short survival. It was formerly called T-cell chronic lymphocytic leukemia." --Arcadian (talk) 18:27, 4 February 2009 (UTC)
I noticed the fact tag you added, so I've added a ref: "In 1989, the French-American-British (FAB) Cooperative Group distinguished five subgroups of T cell leukemia, namely, T cell CLL, T cell PLL, human T lymphotropic virus type I-positive (HTLV-I+), adult T cell leukemia/lymphoma, and Sézary syndrome. 640 When a new entity called large granular lymphocytic leukemia was defined (see Chap. 94), the existence of T cell CLL as a distinct entity became a topic of debate. 641,642,643,644 Because of this finding, the World Health Organization commissioned a panel of experts to draft a new classification of the hematologic neoplasms. 645 At a meeting in November 1997, the panel proposed a categorization of peripheral T cell neoplasms that largely was based on the Revised European-American Lymphoma (REAL) classification (see Chap. 90). 646 However, because of its aggressive clinical behavior, T cell CLL was reclassified under the heading of T cell PLL, without regard to subtle differences in morphology. 647 Even together they account for less than 5 percent of all chronic lymphoid leukemias." --Arcadian (talk) 18:40, 4 February 2009 (UTC)
I think that part of the confusion arises from the historical division of all leukemias into four groups. Once upon a time, if you had a leukemia that was chronic and involved lymphocytes, then you had "Chronic Lymphocytic Leukemia" -- considered a specific disease entity instead of a description of its characteristics. It's like people saying that they're tired all the time, so they have Chronic Fatigue Syndrome, when they might have any one of dozens of other diseases that just happen to present with fatigue. WhatamIdoing (talk) 19:06, 5 February 2009 (UTC)

Causes?[edit]

I just noticed that this article doesn't address the causes of CLL. It seems a little odd. Anyone have a favorite source? WhatamIdoing (talk) 03:11, 26 June 2009 (UTC)

There is no specific cause for CLL. Genetic abberations such as translocations lie at the root of all forms of cancer, and CLL is no exception. I'm sure there are theories... JFW | T@lk 19:39, 24 September 2009 (UTC)
There are a few chemicals like Agent Orange and some poorly described (but obviously present) genetic predispositions, but the fact that the cause isn't known should probably be addressed. I think that readers will want to "know what's not known" for the most common form of leukemia. Also, it would be a good place to identify what's been ruled out (e.g., radiation). WhatamIdoing (talk) 20:01, 24 September 2009 (UTC)
We could have a Causes and Risk factors subsection maybe in the epidemiology section. Rod57 (talk) 18:09, 28 June 2010 (UTC)
one word: Oncogene — Preceding unsigned comment added by 41.34.31.194 (talk) 07:05, 13 August 2011 (UTC)
There are no translocations in CLL, its an exception with that respect. However, there are some genetic aberrations that are very common, i.e. loss of a critical region in chromosomal band 13q14 that occurs in more than 50% of patients [1]. If you remove that region in mice, they get a CLL-like disease, speaking in favor of that region to be important in developing the disease. [2] — Preceding unsigned comment added by Aimee Anouk (talkcontribs) 15:05, 16 May 2013 (UTC)

HSCT[edit]

doi:10.1182/blood-2009-05-206821 Blood - review of indications for allogeneic stem cell transplantation. JFW | T@lk 19:39, 24 September 2009 (UTC)

Cell size[edit]

Does anyone know offhand whether this change is correct? It 'feels right' to me, but my brief search didn't produce a source that addresses this issue, and I don't know. WhatamIdoing (talk) 17:50, 28 September 2009 (UTC)

It's not a full answer, but PMID 1430257 is a good start. --Arcadian (talk) 23:27, 28 September 2009 (UTC)
So B-CLL cells are smaller than any other leukemic cell... but I didn't see any clear comparison to normal lymphocytes in my (very) quick scan. It's a start, though: at least it's not likely to be wildly inaccurate. WhatamIdoing (talk) 06:25, 29 September 2009 (UTC)

Research and Clinical trials[edit]

Could we have a section in/near Treatment mentioning any treatments undergoing late stage clinical trials that may be recruiting patients or nearing marketing approval ? Rod57 (talk) 00:25, 25 March 2010 (UTC)

Kind of yes, and kind of no.
A section titled something like "Research directions", that provides readers with a balanced summary of all B-CLL research would be an excellent thing. A section on "Investigational New Drug trials patients should sign up for" would be extremely unencyclopedic and unbalanced.
We don't want to promote clinical trials or to provide information that is really only interesting to patients (see WP:MEDMOS#Audience), but we do want to let people know how much work is done on this disease. I think that a section that shows the whole scope of research efforts (e.g., causes, epidemiology, prognosis, generic drugs, and non-drug treatments, as well as new drugs) would be very appropriate.
Do you have any good sources for such a section? WhatamIdoing (talk) 00:47, 25 March 2010 (UTC)
No, I was hoping others would. I agree we shouldn't be promoting clinical trials. I mention late stage clinical trials as that is roughly when most possible treatments become notable, and when people are more likely to be interested in them. I'll start a section when I find a good source. Rod57 (talk) 13:34, 23 June 2010 (UTC)
Possibly including Green Tea Extract Appears to Keep Cancer in Check in Majority of CLL Patients which suggests EGCG could be useful one day.
More phase II trials - some results : Thalidomide lenalidomide Bafetinib Theophylline flavopiridol forodesine
CLL trials in Dec 2009 in Europe Rod57 (talk) 13:52, 23 June 2010 (UTC)
Recent phase III trials cladribine vs fludarabine alemtuzumab Rod57 (talk) 14:14, 23 June 2010 (UTC)
We'd be better off with a paper that talks about the state of research -- you know, a "Whither Research for CLL?" opinion in a journal, or perhaps a good summary page at a relevant charity website. Relying on reports about individual clinical trials means that we will attract spam, and might mislead the reader (e.g., by presenting a wildly, although unintentionally, unbalanced summary). WhatamIdoing (talk) 20:06, 23 June 2010 (UTC)

Science News resource, News in Brief: Body & Brain[edit]

Gene therapy for leukemia Web edition: Thursday, August 18th, 2011 "Tweaking immune cells to attack cancer cells in leukemia patients can bring about remission, a small study shows. Scientists at the University of Pennsylvania genetically altered immune T cells to target malignant cells in chronic lymphocytic leukemia patients and mass produced the T cells before injecting them into three patients. The modified cells gravitated to bone marrow, where they killed malignant cells. In two of three patients tested the cancer went into remission, and a portion of the genetically modified T cells persisted, possibly as a cadre of defenders on standby. The researchers report the findings in the Aug. 10 Science Translational Medicine." by Nathan Seppa

99.181.140.213 (talk) 04:33, 26 November 2011 (UTC)

Gene Mutations[edit]

The IGHV mutation status section is imho mistitled with "Gene Mutations". I would expect genetic aberrations to follow under that heading. However, the mutational status of the IGHV genes is a normal process to develop the B-cell immunglobulin genes and also occurs in non-malignant B-cells. In CLL, IGHV mutational status is only used to stratify patients into prognostic subgroups. Therefore, a better title would be "Patient Stratification according to Genetic Markers" or something similar. Gene mutations would e.g. be mutations of the TP53 gene or the ATM gene that both in CLL lead to resistance against chemotherapy and could be adressed under the "Gene Mutations" heading. — Preceding unsigned comment added by Aimee Anouk (talkcontribs) 15:11, 16 May 2013 (UTC)

Chronic Lymphoid Leukaemia? Really?[edit]

Could the medics here confirm that CLL is commonly called "Chronic Lymphoid Leukaemia" as is stated in the lede, and only in the lede? I have only seen this term used here, and never come across it anywhere else. I'd like to remove it altogether, but there are editors here who I would defer to. Thanks -Roxy the dog (resonate) 23:10, 24 March 2014 (UTC)

Firstly, I apologise for paging you, but I am slightly conflicted here, and really would like to ask you to spare a moment to give me an opinion before I boldly remove what I want to remove. WhatamIdoing - Doc James - MastCell
Secondly - There is no secondly. Thanks -Roxy the dog (resonate) 23:51, 8 April 2014 (UTC)
Yes, it's a valid but less popular name. It appears to parallel "myeloid": you use "lymphoid" and "myeloid", or you use "lymphocytic" and "myelogenous". WhatamIdoing (talk) 02:14, 9 April 2014 (UTC)