This page is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
Question on disease classification:
It mentions that CLL is proliferation of B-cells, and that the so-called T-cell CLL is now understood to be another disease group - how about the third type, NK-cells (natural killer cells) -- is NK-cell CLL more like B-cell CLL or the new type of T-cell disease mentioned in the article?
- Deniz
--
Q: "I would like to know the life span of chronic Lymphocytic Leukemia?"
I think that's a tough question to get at because there's a wide range. I wish I knew.
Who am I? I'm the first contributor, otherwise known as IP address 68.169.185.49. My wife was diagnosed with CLL in 1999... and I finally worked up the gumption to post a wiki about it, mistakes and all, in feb 2004, not long after she was treated for first time using the FCR protocol. She's since been treated twice since then with rituximab. So she's 7 years post diagnosis and right now doing well (she's 50 now, relatively young for a CLL patient). Not sure how many times Rituxan is going to to the trick for her or if she'll be able to tolerate it (she's had some Stevens-Johnson syndrome problems.) Also not sure what the next step will be for her.
Anyway, my aim then was to provide a short piece that touched on the key things a new CLL patient is likely to encounter, in not-too-complex language. I figured there's plenty of scholarly writing about CLL out there for the Googling and linking-in for people who want to be amateur hematologists (as seems the fate of CLL patients and their families) without snowing them under with all the molecular biology detail.
So when I came back and looked at the article today came away with the feeling that the article has become become too technical right off the top. I have specific issue with "Risk Stratification" (wha?) - that's a horrible paragraph that doesn't fit with the rest of the body. I may have a crack at this one soon if someone doesn't fix it.
So my simple plea to you hematologists out there: really, really resist the urge to indulge in jargon or highly technical detail. I know it's important in your work, but I think it's out of place for a basic wiki like this.
thanks -
- mister slack
p.s. - did I answer your question?
--
This is a good point - the wiki serves the need of patients and students alike, and all articles implicitly assume some degree of previous knowledge, sometimes it is hard to know where to stop. I think though that the general page should be jargon-free, with links to more in depth articles within Wikipedia for each section (a little like how they do the pages for countries - a seperate page for economics, demographics, military etc. with the general article not overwhelming the reader).
Article [1] - pernicious anaemia is only autoimmune condition that increases risk, while rheumatic heart disease decreases risk. JFW | T@lk 22:06, 21 June 2006 (UTC)
I know a man who was diagnosed in 1977 and was in his early 50's at the time. As of January 2007 he is stll alive and is doing well for a man in his 80's. He has been treated with chemo numerous times.
In his own words: "A lot has happened since I started with a Dr's first words that I had Leukemia and he thought I had about 3 mo's to live. A visit to a specialist and more tests gave me my CLL diagnosis and a lot more hope. As I am now 81 you can see that what you are asking involves years of blood tests and Doctor visits that still go on every three or so months.One thingIhave always had is my faith that all will be well. My ups and downs mentally I have always tried to keep to myself. My condition has been always known to family and friends and to this day can be the subject of questions and conversations.
I find that Doctors have different opinions on which way to treat CLL and even at this stage of life there are decisions to be made on what to do.
My recent visit to the Moffitt Cancer center in Tampa, Fl . where the Dr said you are a lucky one and I don't recommend changing a thing unless there is a sudden change for the worse.There are a lot of new drugs and I never know how they are going to react with different individuals. They could make things worse .I had gone there as my Fla Dr wanted to give me aggressive Drugs to try and wipe out the disease. I don't go to him any more. I would say to you that unless they make new discoveries you will be with CLL for the rest of your life and briefly I say don't let it bother you. I have done always what I have wanted to ,fortunately the Chemo I have taken didn't bother me and when I stopped it the changes were not dramatic.
I suspect that I am on the edge of starting chemo again but that doesn't bother me much.
My first Dr , when I asked him how long I had ,said did you see that man who just left he has CLL and is 90 years old. Just think that could be you."
Yes, that will be me. I am 42 and have a subset of CLL with an excellent prognosis.
72.145.177.118 02:51, 27 January 2007 (UTC)
Staffordshire Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, U.K.
There is evidence for an increased incidence of lymphoproliferative disorders in patients with rheumatoid arthritis (RA). We present the clinical features of 4 patients with RA and chronic lymphatic leukaemia (CLL) which, occurring in a population of 1505 RA patients, represents a significantly increased prevalence of CLL (p less than 0.05) compared to the general population. These patients had significantly lower natural killer cell activity than matched rheumatoid controls (p less than 0.05) or normal controls (p less than 0.01) and we discuss this as a possible mechanism of association.
Chronic Lymphocytic Leukemia (CLL) is a subgroup of Chronic Lymphoid Leukemias. Chronic Lymphoid Leukemias inculdes many different types of leukemia, like CLL, PLL, HCL, Sezary, ATLL, LGLL... Crystal0619 01:05, 11 March 2007 (UTC)
My uncle was just diagnosed with CLL, so of course I googled "CLL" to find information. This article comes up second on the google search, and the disambiguation page for "CLL" comes up third. Its google rank is likely an indication that this is an article people are reading to get information after their loved one, friend, self etc. receives a diagnosis of CLL. Keep in mind that the laymen that will be reading this, like myself, may be in an emotional state after hearing the diagnosis; thus, it is especially important that this article is well organized and accessible.
Many of the technical terms need links to existing articles. As written, the article seems more geared toward the medical community. There is a ton of useful info here, but little of it will make any sense to the layman. Can we strike a balance? -- JenniferOlivia 03:27, 11 April 2007 (UTC)
There needs to be a balance between the technical and general information aspects of this article. As it appears now, I don't believe it is very useful to the new CLL patient, or to the student who is checking out Wikipedia for a "first look" in their research. Since this is the most common form of leukemia, I think the article deserves a technical spin. A few of the wonderful hematologists and oncologists out there could help this article out a lot...and give us a look at the disease that they think would be useful to their patients and to their colleagues in general practice.
My dad succumbed to CLL just 4 years after diagnosis at age 53. I understand the original author's concerns, but for CLL support and general information, the Leukemia & Lymphoma Society, or Web MD would be my first stops.
Suggestions: Could someone discuss the genesis of B cells in the bone marrow, and what seems to make the stem cells go haywire? Are the different chromosomal deletions the result of "sloppy separation" during crossing over or mitosis? Is there a genetic predisposition evident, or is it random or environmental?
Last, (out of pure curiosity), could there be a connection with alpha 1 antitrypsin deficiency?
Rotkopf1 Rotkopf1 00:16, 31 July 2007 (UTC)
This month's Br J Haem has an entire issue full of free papers on the subject of CLL alone! Link JFW | T@lk 01:59, 23 November 2007 (UTC)
I have had CLL since 1992 and am probably not your average reader. There is nothing here that is difficult for me to understand. I find the information well organized and appropriate. It is better information than many Oncologist possess, that is unless they are a specialist. In most cases, a CLL patient should seek out a CLL specialist for treatment and then be followed up by a Hematologist/Oncologist. It does take time and work to reach the level of understanding that is presented here but it should be the goal of every CLL patient to become that well informed. Learning that one has CLL is one gigantic show stopper but it is very empowering to have the knowledge presented in this article when dealing with this disease. With this knowledge one can participate in the decision making process, whether it be watch and wait, a treatment regime or a clinical trial. I would suggest changing the sentence about needing treatment based on high white counts. Knowledgeable Oncologist never treat high counts but follow the recommendations of the NCI and/or using one of the two staging methods mentioned in the article. I would be pleased to share with anyone who has questions regarding CLL. --Jim Lawson 02:44, 8 December 2007 (UTC)
External links to patient support groups (especially online chat boards) and blogsare normally not accepted on Wikipedia. Please read the external links policy and the specific rules for medical articles before adding more external links. WhatamIdoing ( talk) 00:41, 13 January 2008 (UTC)
I accept that it may be policy not to accept patient support groups or online chat groups, but if the rule is delete them, then ALL of them should be deleted and not just target one of them. (just getting my head around this Wikipedia). —Preceding unsigned comment added by 89.240.224.9 ( talk) 15:19, 14 January 2008 (UTC)
I note with some interest that the link to Prof Hamblin's blog was removed about six months ago. As he is one of the top three experts in the world on this subject, this is an amusing edit. The editor at the time cited "too much religion, not enough CLL" as the reason, but it should be noted that there are well over 100 posts on CLL, and the information provided there is of a far higher quality than virtually everything else in the links section. Like the Autosigned comment above, I would suggest that the rules are applied fairly, if they are to be applied at all. As a patient, I would hope that those who maintain this entry remember that in this modern world the internet is where many newly diagnosed people go for good information and help, and that for good or bad, this wiki page is one of the first ports of call. There are, not including the UK CLL forum, Three patient chat groups in the main page links section. The UK CLL Discussion Forum is an established forum that has recently (Jan 2008) changed its web URL, and upgraded its software. It was associated with the charity UK CLL Support Association, which remains linked (but in the wrong category) on the main page, but is now independent of that charity. Please leave the new link to the UK forum linked. Roxy the dog ( talk) 12:25, 15 January 2008 (UTC)
Sorry, I didn't have this page on my watchlist. Yes, of course I object. Wikipedia's external links policy and the specific guidelines for medicine-related articles do not permit the inclusion of external links to non-encyclopedic material, particularly including internet chat boards and e-mail discussion groups. Because I realize that most normal editors haven't spent much time with these policies, please let me provide specific information from the guidelines:
Wikipedia is an encyclopedia, and while it may occasionally be useful to patients or their families, it is not an advertising opportunity for support groups. Please do not re-insert links that do not conform to the standard rules. Any editor, BTW, is welcome to read all of the rules and perform an "audit" in the remaining links. Thanks, WhatamIdoing ( talk) 21:22, 16 April 2008 (UTC)
I deleted the reference to the UCSD protocol http://www.eurekalert.org/pub_releases/2008-02/uoc--gtp021108.php because it's just basic research, and they haven't demonstrated that there's any benefit to it (although it is newsworthy that it's in human trials). If you went to the ASCO web site and looked at their annual meeting you'd find hundreds of studies like this. We don't have room for them all. It might be worth discussing how to deal with basic research like this, but I don't think it belongs in this article. Nbauman ( talk) 01:17, 12 February 2008 (UTC)
There is a new guideline: doi: 10.1182/blood-2007-06-093906 JFW | T@lk 20:19, 22 June 2008 (UTC)
The Epidemiology section is incorrect. see http://bloodjournal.hematologylibrary.org/cgi/content/abstract/100/2/635
Would the contributor consider changing ths? —Preceding unsigned comment added by Steve Madden ( talk • contribs) 22:30, 28 June 2008 (UTC)
Under Epidemiology I have changed "CLL is a disease of the elderly" to "CLL is a disease of older adults." "Elderly" is a relatively nonspecific term; many CLL patients would not be considered elderly but nearly all would be considered "older adults." Lymphomaniac ( talk) 20:02, 2 July 2008 (UTC)
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)
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)
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)
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)
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)
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)
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 ( talk • contribs) 15:11, 16 May 2013 (UTC)
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)
Blood has a series of reviews on CLL here. JFW | T@lk 09:03, 29 July 2015 (UTC)
doi:10.1182/blood-2015-10-620864 JFW | T@lk 08:05, 8 April 2016 (UTC)
doi:10.1111/bjh.14184 JFW | T@lk 13:07, 20 June 2016 (UTC)
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I thought that the survival for CLL that was IgVH positive was about 24 years, while the survival for IgVH negative was 6-8 years. The article cites SEER for a 5-year survival of 83.2%, but they don't distinguish between IgVH +/- or ZAP-70 +/-.
N Engl J Med. 2005 Feb 24;352(8):804-15. Chronic lymphocytic leukemia. Chiorazzi N1, Rai KR, Ferrarini M. PMID 15728813 DOI: 10.1056/NEJMra041720 "Patients with clones having few or no V-gene mutations or with many CD38+ or ZAP-70+ B cells had an aggressive, usually fatal course, whereas patients with mutated clones or few CD38+ or ZAP-70+ B cells had an indolent course."
N Engl J Med. 2003 May 1;348(18):1764-75. ZAP-70 expression as a surrogate for immunoglobulin-variable-region mutations in chronic lymphocytic leukemia. Crespo M1, Bosch F, Villamor N, Bellosillo B, Colomer D, Rozman M, Marcé S, López-Guillermo A, Campo E, Montserrat E.
Look at Figure 4 here.
There was a later article in the NEJM which stated this more explicitly, but I can't find it right now. -- Nbauman ( talk) 00:18, 3 April 2018 (UTC)
doi:10.1016/S0140-6736(18)30422-7 JFW | T@lk 08:38, 15 April 2018 (UTC)
... are not mentioned at all in this article. Why not? - Roxy, the dog. wooF 17:25, 4 October 2019 (UTC)
Hello, we are a group of medical student’s from Queen’s University. We are working to improve this article over the next month and will be posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit. Thank you. Orsini.M1 ( talk) 20:16, 23 November 2020 (UTC) ( Medandchill ( talk) 16:48, 1 December 2020 (UTC))
We noticed that the first sentence in the Prognosis section does not match up to the information mentioned in the rest of the article. The sentence we propose to remove is: "Prognosis depends on the subtype". We propose to insert the following sentences into the beginning of the Prognosis section instead: “Prognosis can be affected by the type of genetic mutation that the person with CLL has [1]. Some examples of genetic mutations and their prognoses are: mutations in the IGHV region are associated with a median overall survival (OS) of more than 20-25 years, while no mutations in this region is associated with a median OS of 8-10 years; deletion of chromosome 13q is associated with a median OS of 17 years; and trisomy of chromosome 12, as well as deletion of chromosome 11q, is associated with a median OS of 9-11 years [2]." Thank you for your time. ( Medandchill ( talk) 04:00, 2 December 2020 (UTC))
We notice that the survival statistics cited in the Prognosis section has no citation, and incorrectly refers to subtypes of CLL which do not exist. We propose removing this sentence, and replace it with a 5-year relative survival statistic from the National Cancer Institute. I wish to replace the sentence “Some subtypes have a median survival of 6-8 years, while others have a median survival of 22 years (which is normal lifespan for older patients). [Citation Needed]” with the following revision: “While prognosis is highly variable and dependent on various factors including these mutations, the average 5-year relative survival is 86.1% [3]” LB1212 ( talk) 00:02, 5 December 2020 (UTC)
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@ WhatamIdoing thank you so much for your feedback and providing those references. I looked at them and I believe that we are discussing the same things, just with different words. Because genetic mutations of CLL are mentioned a few times throughout the page, I believe that replacing "subtypes" with "genetic mutations" will provide a more streamlined reading experience. Genetic mutations is also more precise and accurate compared to just mentioning subtypes. Thank you for your time. ( Medandchill ( talk) 19:14, 7 December 2020 (UTC))
In order to include more detail and a relevant source, we propose to replace the first sentence of the Causes section, “CLL is caused by multiple genetic mutations and epigenetic changes,” with the following sentences: “CLL can be caused by many different genetic mutations, the most common being deletions in the 13q14.3 region, (seen in 50% of CLL cases), as well as trisomy in chromosome 12 (seen in 20% of cases), other deletions (i.e., in 11q22-23, 17p13, or 16q21 regions), and less commonly, translocations (for example, involving the 13q14 region). [1] CLL can also be caused by a number of epigenetic changes, which can be classified into 3 different methylation subgroups (naïve B-cell-like, memory B-cell-like, and intermediate). [2]" -- Step1 jan ( talk) 06:22, 2 December 2020 (UTC)
I propose to change the sentence "Some relevant genetic mutations may be inherited; in around 9% of CLL cases a parent had CLL." in the Causes section for the following three sentences: Some relevant genetic mutations may be inherited. Since there is no one single mutation that causes CLL in all cases, an individual’s susceptibility may be impacted when multiple mutations that increase the risk of CLL are co-inherited. Up until 2014, very few of these mutations or significant “risk alleles” had been identified. [3] -- Maferhuicom
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We propose to replace these two sentences in the introductory section: “Management of early disease is generally with watchful waiting. Infections should more readily be treated with antibiotics.” We propose to replace them with the following: “Early-stage CLL in asymptomatic cases responds better to careful observation, as there is no evidence that early intervention treatment can alter the course of the disease [1]. Immune defects occur early in the course of CLL and these increase the risk of developing serious infection, which should be treated appropriately with antibiotics. [2]” Thank you for your time. Shea46 ( talk) 17:19, 2 December 2020 (UTC)
We noticed that a sentence in the last paragraph of the introduction could be expanded upon to include more specific detail. The sentence we propose to adjust is: “Males are affected more often than females.” We propose to add to the sentence by including a ratio between men and women. Our proposed sentence is as follows: “Men are diagnosed around twice as often as women (6.8 to 3.5 ratio). [3]” Thank you for your time.( Bob Dargin ( talk) 21:50, 2 December 2020 (UTC))
References
To provide context for the term SLL and explain its relation to CLL, we propose to add two sentences to the beginning of the Signs and Symptoms Section: "CLL can be grouped with Small lymphocytic lymphoma (SLL) as one disease with two clinical presentations. [1] Wherein, with CLL, diseased cells propagate from within the bone marrow, in SLL they propagate from within the lymphatic tissue. [2]" Thank you for your time. Orsini.M1 ( talk) 03:41, 5 December 2020 (UTC)
To provide fluidity between the newly proposed changes above and the existing sentences, we propose to edit the first portion of the first sentence in the signs and symptoms section from: "CLL is, in virtually all cases, preceded..." to "CLL and SLL are, in virtually all cases, preceded..." Thank you for your time. Orsini.M1 ( talk) 03:49, 5 December 2020 (UTC)
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This page is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
Question on disease classification:
It mentions that CLL is proliferation of B-cells, and that the so-called T-cell CLL is now understood to be another disease group - how about the third type, NK-cells (natural killer cells) -- is NK-cell CLL more like B-cell CLL or the new type of T-cell disease mentioned in the article?
- Deniz
--
Q: "I would like to know the life span of chronic Lymphocytic Leukemia?"
I think that's a tough question to get at because there's a wide range. I wish I knew.
Who am I? I'm the first contributor, otherwise known as IP address 68.169.185.49. My wife was diagnosed with CLL in 1999... and I finally worked up the gumption to post a wiki about it, mistakes and all, in feb 2004, not long after she was treated for first time using the FCR protocol. She's since been treated twice since then with rituximab. So she's 7 years post diagnosis and right now doing well (she's 50 now, relatively young for a CLL patient). Not sure how many times Rituxan is going to to the trick for her or if she'll be able to tolerate it (she's had some Stevens-Johnson syndrome problems.) Also not sure what the next step will be for her.
Anyway, my aim then was to provide a short piece that touched on the key things a new CLL patient is likely to encounter, in not-too-complex language. I figured there's plenty of scholarly writing about CLL out there for the Googling and linking-in for people who want to be amateur hematologists (as seems the fate of CLL patients and their families) without snowing them under with all the molecular biology detail.
So when I came back and looked at the article today came away with the feeling that the article has become become too technical right off the top. I have specific issue with "Risk Stratification" (wha?) - that's a horrible paragraph that doesn't fit with the rest of the body. I may have a crack at this one soon if someone doesn't fix it.
So my simple plea to you hematologists out there: really, really resist the urge to indulge in jargon or highly technical detail. I know it's important in your work, but I think it's out of place for a basic wiki like this.
thanks -
- mister slack
p.s. - did I answer your question?
--
This is a good point - the wiki serves the need of patients and students alike, and all articles implicitly assume some degree of previous knowledge, sometimes it is hard to know where to stop. I think though that the general page should be jargon-free, with links to more in depth articles within Wikipedia for each section (a little like how they do the pages for countries - a seperate page for economics, demographics, military etc. with the general article not overwhelming the reader).
Article [1] - pernicious anaemia is only autoimmune condition that increases risk, while rheumatic heart disease decreases risk. JFW | T@lk 22:06, 21 June 2006 (UTC)
I know a man who was diagnosed in 1977 and was in his early 50's at the time. As of January 2007 he is stll alive and is doing well for a man in his 80's. He has been treated with chemo numerous times.
In his own words: "A lot has happened since I started with a Dr's first words that I had Leukemia and he thought I had about 3 mo's to live. A visit to a specialist and more tests gave me my CLL diagnosis and a lot more hope. As I am now 81 you can see that what you are asking involves years of blood tests and Doctor visits that still go on every three or so months.One thingIhave always had is my faith that all will be well. My ups and downs mentally I have always tried to keep to myself. My condition has been always known to family and friends and to this day can be the subject of questions and conversations.
I find that Doctors have different opinions on which way to treat CLL and even at this stage of life there are decisions to be made on what to do.
My recent visit to the Moffitt Cancer center in Tampa, Fl . where the Dr said you are a lucky one and I don't recommend changing a thing unless there is a sudden change for the worse.There are a lot of new drugs and I never know how they are going to react with different individuals. They could make things worse .I had gone there as my Fla Dr wanted to give me aggressive Drugs to try and wipe out the disease. I don't go to him any more. I would say to you that unless they make new discoveries you will be with CLL for the rest of your life and briefly I say don't let it bother you. I have done always what I have wanted to ,fortunately the Chemo I have taken didn't bother me and when I stopped it the changes were not dramatic.
I suspect that I am on the edge of starting chemo again but that doesn't bother me much.
My first Dr , when I asked him how long I had ,said did you see that man who just left he has CLL and is 90 years old. Just think that could be you."
Yes, that will be me. I am 42 and have a subset of CLL with an excellent prognosis.
72.145.177.118 02:51, 27 January 2007 (UTC)
Staffordshire Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, U.K.
There is evidence for an increased incidence of lymphoproliferative disorders in patients with rheumatoid arthritis (RA). We present the clinical features of 4 patients with RA and chronic lymphatic leukaemia (CLL) which, occurring in a population of 1505 RA patients, represents a significantly increased prevalence of CLL (p less than 0.05) compared to the general population. These patients had significantly lower natural killer cell activity than matched rheumatoid controls (p less than 0.05) or normal controls (p less than 0.01) and we discuss this as a possible mechanism of association.
Chronic Lymphocytic Leukemia (CLL) is a subgroup of Chronic Lymphoid Leukemias. Chronic Lymphoid Leukemias inculdes many different types of leukemia, like CLL, PLL, HCL, Sezary, ATLL, LGLL... Crystal0619 01:05, 11 March 2007 (UTC)
My uncle was just diagnosed with CLL, so of course I googled "CLL" to find information. This article comes up second on the google search, and the disambiguation page for "CLL" comes up third. Its google rank is likely an indication that this is an article people are reading to get information after their loved one, friend, self etc. receives a diagnosis of CLL. Keep in mind that the laymen that will be reading this, like myself, may be in an emotional state after hearing the diagnosis; thus, it is especially important that this article is well organized and accessible.
Many of the technical terms need links to existing articles. As written, the article seems more geared toward the medical community. There is a ton of useful info here, but little of it will make any sense to the layman. Can we strike a balance? -- JenniferOlivia 03:27, 11 April 2007 (UTC)
There needs to be a balance between the technical and general information aspects of this article. As it appears now, I don't believe it is very useful to the new CLL patient, or to the student who is checking out Wikipedia for a "first look" in their research. Since this is the most common form of leukemia, I think the article deserves a technical spin. A few of the wonderful hematologists and oncologists out there could help this article out a lot...and give us a look at the disease that they think would be useful to their patients and to their colleagues in general practice.
My dad succumbed to CLL just 4 years after diagnosis at age 53. I understand the original author's concerns, but for CLL support and general information, the Leukemia & Lymphoma Society, or Web MD would be my first stops.
Suggestions: Could someone discuss the genesis of B cells in the bone marrow, and what seems to make the stem cells go haywire? Are the different chromosomal deletions the result of "sloppy separation" during crossing over or mitosis? Is there a genetic predisposition evident, or is it random or environmental?
Last, (out of pure curiosity), could there be a connection with alpha 1 antitrypsin deficiency?
Rotkopf1 Rotkopf1 00:16, 31 July 2007 (UTC)
This month's Br J Haem has an entire issue full of free papers on the subject of CLL alone! Link JFW | T@lk 01:59, 23 November 2007 (UTC)
I have had CLL since 1992 and am probably not your average reader. There is nothing here that is difficult for me to understand. I find the information well organized and appropriate. It is better information than many Oncologist possess, that is unless they are a specialist. In most cases, a CLL patient should seek out a CLL specialist for treatment and then be followed up by a Hematologist/Oncologist. It does take time and work to reach the level of understanding that is presented here but it should be the goal of every CLL patient to become that well informed. Learning that one has CLL is one gigantic show stopper but it is very empowering to have the knowledge presented in this article when dealing with this disease. With this knowledge one can participate in the decision making process, whether it be watch and wait, a treatment regime or a clinical trial. I would suggest changing the sentence about needing treatment based on high white counts. Knowledgeable Oncologist never treat high counts but follow the recommendations of the NCI and/or using one of the two staging methods mentioned in the article. I would be pleased to share with anyone who has questions regarding CLL. --Jim Lawson 02:44, 8 December 2007 (UTC)
External links to patient support groups (especially online chat boards) and blogsare normally not accepted on Wikipedia. Please read the external links policy and the specific rules for medical articles before adding more external links. WhatamIdoing ( talk) 00:41, 13 January 2008 (UTC)
I accept that it may be policy not to accept patient support groups or online chat groups, but if the rule is delete them, then ALL of them should be deleted and not just target one of them. (just getting my head around this Wikipedia). —Preceding unsigned comment added by 89.240.224.9 ( talk) 15:19, 14 January 2008 (UTC)
I note with some interest that the link to Prof Hamblin's blog was removed about six months ago. As he is one of the top three experts in the world on this subject, this is an amusing edit. The editor at the time cited "too much religion, not enough CLL" as the reason, but it should be noted that there are well over 100 posts on CLL, and the information provided there is of a far higher quality than virtually everything else in the links section. Like the Autosigned comment above, I would suggest that the rules are applied fairly, if they are to be applied at all. As a patient, I would hope that those who maintain this entry remember that in this modern world the internet is where many newly diagnosed people go for good information and help, and that for good or bad, this wiki page is one of the first ports of call. There are, not including the UK CLL forum, Three patient chat groups in the main page links section. The UK CLL Discussion Forum is an established forum that has recently (Jan 2008) changed its web URL, and upgraded its software. It was associated with the charity UK CLL Support Association, which remains linked (but in the wrong category) on the main page, but is now independent of that charity. Please leave the new link to the UK forum linked. Roxy the dog ( talk) 12:25, 15 January 2008 (UTC)
Sorry, I didn't have this page on my watchlist. Yes, of course I object. Wikipedia's external links policy and the specific guidelines for medicine-related articles do not permit the inclusion of external links to non-encyclopedic material, particularly including internet chat boards and e-mail discussion groups. Because I realize that most normal editors haven't spent much time with these policies, please let me provide specific information from the guidelines:
Wikipedia is an encyclopedia, and while it may occasionally be useful to patients or their families, it is not an advertising opportunity for support groups. Please do not re-insert links that do not conform to the standard rules. Any editor, BTW, is welcome to read all of the rules and perform an "audit" in the remaining links. Thanks, WhatamIdoing ( talk) 21:22, 16 April 2008 (UTC)
I deleted the reference to the UCSD protocol http://www.eurekalert.org/pub_releases/2008-02/uoc--gtp021108.php because it's just basic research, and they haven't demonstrated that there's any benefit to it (although it is newsworthy that it's in human trials). If you went to the ASCO web site and looked at their annual meeting you'd find hundreds of studies like this. We don't have room for them all. It might be worth discussing how to deal with basic research like this, but I don't think it belongs in this article. Nbauman ( talk) 01:17, 12 February 2008 (UTC)
There is a new guideline: doi: 10.1182/blood-2007-06-093906 JFW | T@lk 20:19, 22 June 2008 (UTC)
The Epidemiology section is incorrect. see http://bloodjournal.hematologylibrary.org/cgi/content/abstract/100/2/635
Would the contributor consider changing ths? —Preceding unsigned comment added by Steve Madden ( talk • contribs) 22:30, 28 June 2008 (UTC)
Under Epidemiology I have changed "CLL is a disease of the elderly" to "CLL is a disease of older adults." "Elderly" is a relatively nonspecific term; many CLL patients would not be considered elderly but nearly all would be considered "older adults." Lymphomaniac ( talk) 20:02, 2 July 2008 (UTC)
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)
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)
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)
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)
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)
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)
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 ( talk • contribs) 15:11, 16 May 2013 (UTC)
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)
Blood has a series of reviews on CLL here. JFW | T@lk 09:03, 29 July 2015 (UTC)
doi:10.1182/blood-2015-10-620864 JFW | T@lk 08:05, 8 April 2016 (UTC)
doi:10.1111/bjh.14184 JFW | T@lk 13:07, 20 June 2016 (UTC)
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I thought that the survival for CLL that was IgVH positive was about 24 years, while the survival for IgVH negative was 6-8 years. The article cites SEER for a 5-year survival of 83.2%, but they don't distinguish between IgVH +/- or ZAP-70 +/-.
N Engl J Med. 2005 Feb 24;352(8):804-15. Chronic lymphocytic leukemia. Chiorazzi N1, Rai KR, Ferrarini M. PMID 15728813 DOI: 10.1056/NEJMra041720 "Patients with clones having few or no V-gene mutations or with many CD38+ or ZAP-70+ B cells had an aggressive, usually fatal course, whereas patients with mutated clones or few CD38+ or ZAP-70+ B cells had an indolent course."
N Engl J Med. 2003 May 1;348(18):1764-75. ZAP-70 expression as a surrogate for immunoglobulin-variable-region mutations in chronic lymphocytic leukemia. Crespo M1, Bosch F, Villamor N, Bellosillo B, Colomer D, Rozman M, Marcé S, López-Guillermo A, Campo E, Montserrat E.
Look at Figure 4 here.
There was a later article in the NEJM which stated this more explicitly, but I can't find it right now. -- Nbauman ( talk) 00:18, 3 April 2018 (UTC)
doi:10.1016/S0140-6736(18)30422-7 JFW | T@lk 08:38, 15 April 2018 (UTC)
... are not mentioned at all in this article. Why not? - Roxy, the dog. wooF 17:25, 4 October 2019 (UTC)
Hello, we are a group of medical student’s from Queen’s University. We are working to improve this article over the next month and will be posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit. Thank you. Orsini.M1 ( talk) 20:16, 23 November 2020 (UTC) ( Medandchill ( talk) 16:48, 1 December 2020 (UTC))
We noticed that the first sentence in the Prognosis section does not match up to the information mentioned in the rest of the article. The sentence we propose to remove is: "Prognosis depends on the subtype". We propose to insert the following sentences into the beginning of the Prognosis section instead: “Prognosis can be affected by the type of genetic mutation that the person with CLL has [1]. Some examples of genetic mutations and their prognoses are: mutations in the IGHV region are associated with a median overall survival (OS) of more than 20-25 years, while no mutations in this region is associated with a median OS of 8-10 years; deletion of chromosome 13q is associated with a median OS of 17 years; and trisomy of chromosome 12, as well as deletion of chromosome 11q, is associated with a median OS of 9-11 years [2]." Thank you for your time. ( Medandchill ( talk) 04:00, 2 December 2020 (UTC))
We notice that the survival statistics cited in the Prognosis section has no citation, and incorrectly refers to subtypes of CLL which do not exist. We propose removing this sentence, and replace it with a 5-year relative survival statistic from the National Cancer Institute. I wish to replace the sentence “Some subtypes have a median survival of 6-8 years, while others have a median survival of 22 years (which is normal lifespan for older patients). [Citation Needed]” with the following revision: “While prognosis is highly variable and dependent on various factors including these mutations, the average 5-year relative survival is 86.1% [3]” LB1212 ( talk) 00:02, 5 December 2020 (UTC)
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@ WhatamIdoing thank you so much for your feedback and providing those references. I looked at them and I believe that we are discussing the same things, just with different words. Because genetic mutations of CLL are mentioned a few times throughout the page, I believe that replacing "subtypes" with "genetic mutations" will provide a more streamlined reading experience. Genetic mutations is also more precise and accurate compared to just mentioning subtypes. Thank you for your time. ( Medandchill ( talk) 19:14, 7 December 2020 (UTC))
In order to include more detail and a relevant source, we propose to replace the first sentence of the Causes section, “CLL is caused by multiple genetic mutations and epigenetic changes,” with the following sentences: “CLL can be caused by many different genetic mutations, the most common being deletions in the 13q14.3 region, (seen in 50% of CLL cases), as well as trisomy in chromosome 12 (seen in 20% of cases), other deletions (i.e., in 11q22-23, 17p13, or 16q21 regions), and less commonly, translocations (for example, involving the 13q14 region). [1] CLL can also be caused by a number of epigenetic changes, which can be classified into 3 different methylation subgroups (naïve B-cell-like, memory B-cell-like, and intermediate). [2]" -- Step1 jan ( talk) 06:22, 2 December 2020 (UTC)
I propose to change the sentence "Some relevant genetic mutations may be inherited; in around 9% of CLL cases a parent had CLL." in the Causes section for the following three sentences: Some relevant genetic mutations may be inherited. Since there is no one single mutation that causes CLL in all cases, an individual’s susceptibility may be impacted when multiple mutations that increase the risk of CLL are co-inherited. Up until 2014, very few of these mutations or significant “risk alleles” had been identified. [3] -- Maferhuicom
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We propose to replace these two sentences in the introductory section: “Management of early disease is generally with watchful waiting. Infections should more readily be treated with antibiotics.” We propose to replace them with the following: “Early-stage CLL in asymptomatic cases responds better to careful observation, as there is no evidence that early intervention treatment can alter the course of the disease [1]. Immune defects occur early in the course of CLL and these increase the risk of developing serious infection, which should be treated appropriately with antibiotics. [2]” Thank you for your time. Shea46 ( talk) 17:19, 2 December 2020 (UTC)
We noticed that a sentence in the last paragraph of the introduction could be expanded upon to include more specific detail. The sentence we propose to adjust is: “Males are affected more often than females.” We propose to add to the sentence by including a ratio between men and women. Our proposed sentence is as follows: “Men are diagnosed around twice as often as women (6.8 to 3.5 ratio). [3]” Thank you for your time.( Bob Dargin ( talk) 21:50, 2 December 2020 (UTC))
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To provide context for the term SLL and explain its relation to CLL, we propose to add two sentences to the beginning of the Signs and Symptoms Section: "CLL can be grouped with Small lymphocytic lymphoma (SLL) as one disease with two clinical presentations. [1] Wherein, with CLL, diseased cells propagate from within the bone marrow, in SLL they propagate from within the lymphatic tissue. [2]" Thank you for your time. Orsini.M1 ( talk) 03:41, 5 December 2020 (UTC)
To provide fluidity between the newly proposed changes above and the existing sentences, we propose to edit the first portion of the first sentence in the signs and symptoms section from: "CLL is, in virtually all cases, preceded..." to "CLL and SLL are, in virtually all cases, preceded..." Thank you for your time. Orsini.M1 ( talk) 03:49, 5 December 2020 (UTC)
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