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65 :-2:1
95% , 5% .

, -1/3,

90% BCL-2 -





12+, 14q+, 14(q11, q32)



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25%
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CML
L- .

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-77%
-2%-
/-2%

Clinical features and presentation


Often asymptomatic; lymphocytosis (>5.0 109/L) on
routine FBC.
With more advanced disease: lymphadenopathy: painless,
often symmetrical, splenomegaly (66%), hepatomegaly and
ultimately BM failure due to infiltration causing anaemia,
neutropenia and thrombocytopenia.
Recurrent infection due to acquired
hypogammaglobulinaemia: esp.Herpes zoster.
Patients with advanced disease: weight loss, night sweats,
general malaise.
Autoimmune phenomena occur; DAT +ve in 1020% cases,
warm antibody
AIHA in <50% these cases. Autoimmune thrombocytopenia
in 12%.

Diagnosis
FBC: lymphocytosis >5.0 109/L; usually
>20 109/L, occasionally >400 109/L;
anaemia, thrombocytopenia and neutropenia
absent in early stage
CLL; autoimmune haemolysis
thrombocytopenia may occur at any stage.

Blood film: lymphocytosis with mature


appearance; characteristic artefactual
damage to cells in film preparation produces
numerous smear cells (Note:
absence of smear cells should prompt review
of diagnosis); spherocytes,
polychromasia and 4 retics if AIHA; 5
platelets if BM failure or ITP.

:
10-20% (+)
50%
1-2%


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Ig
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TNF, IL6- . IL6 ,
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IL6


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Ig- : IgA 20-25%,
IgG 55-60%, IgM, IgD
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: - 60%
- 25%
- 15%
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15%

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8,13,14,16,22-
3,5,7,9,11,15,19-
13- .

: t(4;14), t(14;16), del(17p), del(13),

: t(4;14)


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50-60%
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10 Gy, 6 Gy
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50-400- 30%
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55

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