Exam Cram

• Cancer of lymphoid cells in bone marrow (leukaemia), translocation t11:14

• Presentation: often asymptomatic, incidentally picked up on FBC with raised WCC 30-40 (lymphocytes +++)

• Diagnosis: peripheral blood immunotyping

• Management: low grade chemotherapy, blood transfusions

Outline

Background

• Cancer of lymphoid progenitor cell, precursor to lymphocytes

• Translocation t11:14

• Managed by Haematology

Assessment

History

• Can be asymptomatic

• Gradual decline

Examination

• Splenomegaly (commonest cause with Myelofibrosis )

Investigations

• Raised WCC (particularly lymphocytes): 20-40 +

• Anaemia: 

• Peripheral blood immunotyping

Diagnosis & Classification

• Diagnostic criteria: peripheral blood immunotyping

Management

• Anaemia: aim Hb > 70, recurrent blood transfusions

• Chemotherapy if symptomatic otherwise monitor

Haem Reg Notes

Markers of increased severity

• TP53 gene- tumour suppression deletion

• Increased B2M (beta-2microglobulin): reflect disease stage and tumour burden

• Impaired renal function

• Elevated thymidine kinase

• 17p(del) on chromosome typing

Management

Indication to start chemotherapy: 

• Weight loss > 10%

• Extreme fatigue; fevers, night sweats

• Bone marrow failure

• AI anaemia or thrombocytopenia not responding to steroids

• Progressive splenomegaly

• Massive lymphadenopathy 

• Lymphocyte increase > 50% in less than 6 months

Chemotherapy: 

• Fludarabine regimes

• Initially up to 80% respond

No evidence that early treatment improves outcomes. 

Cause of Anaemia

1. Bone marrow infiltration (more commonly than haemolysis)

2. Haemolysis

Resources and References

Written in 2025.