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Institute of Cancer, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, London, United Kingdom. Chronic lymphocytic leukemia (CLL) remains incurable, with patients having a clinical course of disease progression to requirement for treatment followed by an unremitting course of relapse of disease. The single biggest risk factor of getting CLL is a family history of CLL or other lymphoid cancers.
Half the battle is making sure the initial diagnosis of CLL is correct, since there are many “kissing cousins” that sort of look like CLL and might fool the local ‘strip-mall oncologist’ that sees just one or two cases of CLL each year. When the disease is present mostly in the blood (as demonstrated by elevated absolute lymphocyte counts in a CBC blood test) it is called CLL. He also thinks a bone marrow biopsy (BMB) is not needed at the time of diagnosis except in special circumstances.
Alongside is a picture of what CLL cells look like when they are viewed under a microscope. The Binet system considers three potential sites of lymph nodes (cervical, axillary, inguinal – see picture below for locations) as well as spleen and liver.
CLL staging is done using either one or combination of Rai and Binet staging systems along with CBC and physical examination. The biggest advances in our understanding of CLL has come in the area of modern prognostic indicators. But how about the patients’  “planning purposes”?  We too have lives, families, finances and stuff that can benefit from having a rough idea of what is coming at us round the curve in the road. One of the most interesting and useful aspects of this paper are the excellent flowcharts Dr. But if the patient is younger and in better physical shape, the choice of therapy depends on whether or not he has the dreaded p53 deletion (FISH test). While this flowchart may look simplistic, notice there is “or clinical trial” at two different points in the chart. MY HUSBAND DIED LAST JUNE FROM CLL, OR RATHER COMPLICATIONS ASSOCIATED WITH THE TREATMENT OF CLL. Chaya thank you for keeping us informed and taking the time to break things down in terms we can understand. I find these comments very interesting as even this small sample shows the wide variety of ways that CLL can affect us. The doctor here referred me to the local CLL Supportorg for info., also ro the Macmillan society (a charity), I do wish they had been much more currant and factual, like you are!
I am now 27 months into remission after FCR ( my second visit to chemo)and trying very hard to justify my membership in the SKI club.????? I read you regularly and have taken many aspects of my treatment into my own hands….HOW!!!
Yes I understand that at the present time (I don’t believe in miracles) the ultimate prognosis is terminal, but the days weeks years ahead of me until that time I want to maximise and enjoy life to the fullest during that period what ever it may be. It is also interesting that I have found music which has given my overworked brain box a different passion to placate the constant and unrelenting thought processes about where I am and where I am going.
Thank you for another clear abstract including the graphics and charts, and of course your input. There most certainly is reason to expect individual patients to experience adverse outcomes with therapy, but the flow chart that he utilizes makes it clear that treatment should not be considered until patients become symptomatic. Dr.Shanafelt and his colleagues at the Mayo Clinic wrote a similar and equally informative article in 2006 which appeared in the Annals of Internal Medicine. Articles such as these are very useful to help us to learn more about best practices and, at times, to educate our treating physicians, but as they are written by physicians for physicians, there is no reason to feel animus over any specific positions taken or advice offered by the authors…they are not telling us (as patients) what we should or should not do. I was just diagnosed in September after a routine physical exam and blood work that showed an elevated Lymph count of 28K.
I believe there are no hard and fast rules about age restrictions in order to qualify for FCR treatment.
No disrespect intended to your fellow brethren in white, but we are adult patients, we have a cancer and need medical care, but that does not mean we have signed away our rights as consumers or adult human beings.
I’ve been reading your site for quite a while now and have never properly thanked you for your hard work and advocacy. Quotation: “The single biggest risk factor of getting CLL is a family history of CLL or other lymphoid cancers. Among the strongest risk factors for the development of CLL is a family history of this or other lymphoid malignancies.
Environmental factors as well as stress, radiation, prior exposure to pesticides, history of long standing and unresolved inflammatory disease, prior history of multiple bouts of pneumonia, viral disease (mononucleosis?) – some or all of these could have an impact on the incidence of CLL. I only write this to say to those at the watch and wait stage that there seems to be no automatic progression and it might be best to take it as it comes.
I was diagonosed with CLL in Dec 08 at the age of 47 with the 13q deletion, i was suffering from fatigue, constantly getting infections, and for the most part just feeling miserable. Like many others that have responded similarly, I also prefer to be informed and know my prognostic markers. As an action-oriented individual, having this information is definitely a god-send and has not spiraled me into depression.
He was given a lymph biopsy and after cbc blood test results, his oncologyst started him on 4 weeks of Cholorambucil on Nov 12.
He has had no other marker testing at all, and has now just been asked for the 2nd time not to return for another 6 months.
I was struck by his lack of empathy, and the coldness of his delivery.I immediately lost confidence in the possibility of his treating me in the future, should I (hopefully not) ever need it. Hello evansjenny, concur with your comments am a 48 year old male diagnosed 10 months ago and am in W&W. I wouldn’t gainsay the familiar aspect in getting CLL but with all due respect, I still think that saying CLL is a familiar cancer is a much too strong expression. 5% to 10% of them have a familiar disposition or with other words 90% to 95% have no familiar disposition.
The risk in getting CLL for first-degree relatives if a lineal ancestor had CLL is about 2 to 7 times higher than in other population. So even if there is a ancestor with CLL there is an absolute low level risk to get this kind of cancer in comparison to most common other ones.
The familial nature of the disease gives us great hope of finding what makes this disease tick, what particular or set of specific genetic lesions cause this disease. I agree absolutely that probably the only known hard fact is the familial one, to answer the question: What is the risk profile to catch a CLL?
And last but not least, the risk of a traffic death in the USA (2006) is about six times higher than the risk of a familial CLL. What I try to say is everybody should find their individual balance in handling risks: In the one hand the natural (high) risk of life itself and the other hand the (low) risk of a familial CLL.
Fear is a very dangerous thing, especially when people jump to conclusions that are not justified by facts. Thanks again for more info to help us make that hard call of when to begin treatment and with what.
CLL Topics Updates does not provide medical advice and its contents are for information only. Surgery at the history of level i neck trauma to top qualityОписание: If you have ever had swollen neck glands, you know how fastЧешется голова и шея. Swollen lymph nodes prove that you have problem in some parts of the body and you might feel painful, tender in lymph glands, runny nose, fever, sore throat, swollen limb, night sweat, etc. Simply, you rub castor oil on the affected area directly; use a flannel, a plastic bag, a heating pad to cover it.
Then you take some teaspoons of the mixture in every morning before breakfast (you use with juice or fresh water).
You need roots, flowers, leaves, or other parts of Echinacea, A? lemon grass, A? spearmint leaves, and some stevia leaves.
Mix all the ingredients together; brew it with water for several minutes before tasting it. Similar to other home remedies for swollen lymph nodes, garlic is a helpful ingredient in healing the condition. You combine a teaspoon of honey, a glass of warm water, lemon juice and drink it immediately. One of the simplest and cheapest home remedies for swollen lymph nodes in ear, neck, and other parts of the body is apple cider vinegar, which has anti-bacterial property that can soothe the problem very well.


Mix a teaspoon of honey, a teaspoon of lemon juice, and a tablespoon of apple cider vinegar with a glass of warm water and drink it immediately.
Also, you can combine a cup of warm water, a tablespoon of apple cider vinegar, and a teaspoon of salt, gargle it several times each day. Cleavers is a kind of herb that can encourage functions of every organ, lymphatic system in your body.
SpriurulinaA is high in B vitamins, antioxidants, protein, and other nutrients that are perfect for your health.
If you want to get more useful and home remedies for many diseases, you might visit our main Home RemediesA page.
After reading the article about top 8 home remedies for swollen lymph nodes, I hope that you have learned some useful treatments for healing the problem in neck, ear, and other parts of the body. VKool encourages comments, but please remember: Play nice, keep it clean, stay on-topic, and avoid promotional content. Over the past decade there have been major advances in understanding of the pathophysiology of CLL and in the treatment of this disease. Gribben point out, over the last decade we have made huge strides in better understanding of the pathology of CLL.
Of these, more than half (just over 9,000) will be men.  No question, there does seem to be a slight male bias in this disease. What used to be called T-cell CLL has now been classified as T-prolymphocytic leukemia and a totally different beast. He uses a BMB when it is time for treatment, in order to get a good sense of the lay of the land. The Rai staging system is used most often in the USA and the Binet system is used in Europe.
It therefore focuses on ALC, presence of more and larger swollen lymph nodes over time, swollen spleen and liver, all of them choke full of CLL cells. We have discussed the relevance of Rai Staging in much greater detail in an earlier article. Patients are staged according to the number of these five possible sites where disease is present. Gribben points out, “a current challenge is to understand how we should use this new information in clinical practice”.
Certainly, if I were to be diagnosed with CLL I would want to have as much prognostic information as possible for planning purposes. But I accept we live in the real world, we understand limited time is available to each patient during expert consultations.
Patients who learn about all this difficult stuff on their own time, patients who come to you for the facts, just the facts, and all the hand holding and emotional and educational support is done elsewhere? Gribben follows patients every three months for physical examination, history and blood counts. The present day standard of care is to initiate treatment only when the patient is symptomatic, until then the safest course seems to be good old Watch & Wait.
Gribben has a full section on treatment of elderly patients who are not in the pink of health even without CLL. Alemtuzumab (Campath) is one of the few drugs that is known to work well with p53 deleted patients. This covers all the other drugs and their various combinations, both recent and a few years older. Long as this review has been, I have done it scant justice since there is a lot more detail than I have addressed.
The familial nature of CLL and its impact on risk of incidence is the opinion of experts, not just my take on things.
You really are excellent; you credit people with brains and do not seem to think that age is an automatic disqualifier to unddrstanding and independent thought.
It is not an easy condition to think about especially as it took 6 months from the end of treatment for my counts to get above the critical level. We as CLL patienhts tend to take some of this information personally and fail to realize that articles such as these are written for the professional.
It’s given me so much more information about my illness than my doctor ever has explained.
I’ve had one round at its come back but I’m still going working, exercising and enjoying my life! I was diagnosed at 48, 4yrs ago, and my mother had cll diagnosed at about 50, I asked my dr. I find it to be as informative as it can be and in plain language for most of us to understand. A number of familial clusters of CLL have been reported, and there is genetic anticipation, the process whereby the median age at onset in a child of a multi generation family with malignancy is younger than that of the parent generations.
How appropriate, fatigue is the most annoying permanent symptom because it limits what I can get done in a day.
Lymph nodes or lymph glands are very important because it can fight bacteria, viruses, and causes of other sickness. This oil can kill ringworms, good for your fine lines and wrinkles, treat acne, scars, improve hair, cure constipation, get rid of joint pain, arthritis, etc. It originally came from North America and it can be sued in insect bites, sore throat, toothache, respiratory infections.
This is one of the best herbs to get rid of swollen lymph nodes that you can do at home every day. It is also easily found in every market and you totally can use this ingredient to get rid of swollen glands.
This ingredient is one of the best home remedies for swollen lymph nodes you should take right away. This article is for informational purpose only, so you should go to see the doctor immediately if you cannot get better effect from those home remedies. Gribben is one of the experts whose publications I track as a matter of course.  His most recent article in Blood does a great job of pulling together all the modern understanding of CLL and guidelines for frontline treatment of patients.
This has led to greatly increased response rates and durations of response, but until recently little evidence that this had led to improvement in survival. If you are a very young CLL patient, consider yourself specially “blessed” – not that you asked for it or anything.
When statistics are examined from 1975 through 2006, there does not seem to be any increase in this rate. But when rubber meets the road there is no real difference between the CLL and SLL and they are treated the same way.
It may also be necessary to do a BMB sooner if the patient has cytopenias (low red blood cells and low platelets), to figure out if the root of the problem is autoimmune disease (AIHA or ITP) or compromised bone marrow function.
Both systems have become a tad of date as we have learned more about CLL, but both staging systems still retain value and it is therefore important for us to learn about them.
Anemia and thrombocytopenia (reduced red blood cells and platelets, respectively) is attributed to bone marrow getting progressively packed with CLL cells and therefore preventing the bone marrow from producing new red blood cells and platelets as the old cells get worn out and die.
In a less fortunate 20% of patients the disease is advanced and accompanied with anemia and thrombocytopenia. Anemia (hemoglobin less than 10) and thrombocytopenia (platelets less than 100K) are the other two factors taken into account in Binet staging.
Gribben reviews the importance of FISH, IgVH gene mutation status, ZAP70, CD38 expression in determining the risk status of patients. If you got CLL, you would want to know all the prognostic information for “planning purposes”. If the track record shows an indolent disease, it may be OK to see the patient less frequently.
Thank you Doc, for your thoughtful and well considered comments.  Muchas gracias, on behalf of several thousand of our determined members.
What gives and can these features help in defining mechanisms of disease that would suggest better targeted therapies, particularly in the newer clinical trial areas? More information only has helped me at least understand what I am being told and stimulates better questions.
For me to leave my life in he hands of anyone regardless of who they are without being fully informed of all aspects of the disease and treatment options is unthinkable.
Because of your dedication and diligence we are informed about CLL in our lives or that of loved ones.


Gribben was my oncologist when he was at Dana Farber Cancer Institute and I can personally attest to his excellence, and beyond that he is a very humble and warm human being. I am a former Marine Viet Nam vet, was over in 1967 an 1968, It is said, i have this from agent orange . Like many others who have stated they do like to be informed on their own disease and how it does progress or what the next step would be, I feel it is important to be as knowledgeable as you can to make the right decisions for your own health. I believe it’s always good to get a second opinion, especially regarding such an important diagnosis.
Familial CLL is a scientifically justified term, and while I did not invent it or do the research to prove it, I fully agree with it. Acting as antibiotic, Echinacea is great in fighting bacteria and viruses if you get swollen lymph nodes in neck, ear, or other areas of the body. The reason is that garlic is good in anti-inflammatory property that can reduce swelling and pain very well. As the result, you should take effectiveness of this herb to get rid of swollen lymph nodes in parts of the body. Spirulina contains anti-inflammatory property, omega-3 fatty acids that can improve your health and reduce swollen lymph nodes well.
But until very recently there has been no concrete proof that patients were living any longer because of all this new fangled stuff.
It seems CLL cells are a bit more fragile than normal B-cells and they are more likely to get bent out of shape in the process of making a microscope slide of the sample. Flow cytometry looks for this unique fingerprint and it is very useful in confirming CLL – as well as ruling out some of the “kissing cousin” cancers. B-symptoms (weight loss, fevers, night sweats, extreme fatigue) are present at time of diagnosis in 20% of cases and may require treatment right away. But a generic Joe Patient walks in, unprepared and uninformed, he may not be able to deal with the bad news and it takes up too much of professional time walking him through all this complicated stuff, not to mention holding his hands as it were. How do you feel about patient-friendly educational websites that present credible information such as this excellent article of yours, reviews that are CME (continuing medical education) suitable to layperson patient audience? He pays special attention to any changes in symptoms (such as development of B-symptoms, increasing adenopathy at one site, elevated LDH – lactate dehydrogenase) since this may suggest transformation to more aggressive Richter’s disease. Recent comparisons between fludarabine versus chlorambucil as single agent therapies in such patients have shown little advantage for fludarabine. Gribben does not mention a couple of others, Revlimid, flavopiridol etc, that are also thought to work in these patients. Gribben gives a good review of the results obtained in many of the clinical trials that have been pivotal in defining the advantages and disadvantages of these other options. FCR (2x) seemed to work well but then some lymph nodes began to increase and I also has anemia and low WBC so they have changed regime to R plus prednisone with great response but I may not be able to use FCR or maybe can later but the information above will help me understand my options. By December 2002 I was in treatment with RFC which I had through May 2003, the full protocol. I now have turned 40 and am trying to absorb the latest information to really understand what it is I have.My health is very good and my counts have not moved yet. I go to a university med center for my follow up, and no one seems at all interested in the fact that my mom had it. As far as taking a proactive approach, I highly recommend doing what you can to stay very healthy while you watch and wait. The way to use garlic is you should eat some cloves of garlic every day to eliminate swollen glands, or you can take some garlic capsules before consulting with your doctor. Questions remain including; what is the optimal first line treatment and its timing and is there any role of maintenance therapy or stem cell transplantation in this disease? Even more important, there is a lot of confusion about when to start therapy and what to use as frontline treatment. Gribben recommends a proper biopsy of an accessible lymph node and review of the biopsy specimen by an expert pathologist for confirmation of SLL. If you have not done so already, please read our recent articles on CBC, ALC, red blood cells and platelets to become familiar with the acronyms. Flow cytometry looks not only to see what CDs are present, but also how densely they are packed on the cell.
It is particularly important to rule of more dangerous varieties of B-cell cancers such as mantle cell lymphoma. Chlorambucil is easier to tolerate, cheaper, easier to dispense and has fewer adverse effects. But that is perhaps because these drugs are not quite there in terms of full fledged clinical trials certifying their usefulness in p53 deleted patients. FCR is potent chemoimmunotherapy and it gives excellent response rates and deep responses to many patients. I encourage everyone to become as informed as possible and part of that is to learn to manage our anxiety that is quite a job and very challenging to help our spouse. Your insight and up to date information is helping me quench my thirst to understand this disease.
Gribben would be the first to admit he does not have professional training as a psychologist – how can he tell whether or not a given patient is a good candidate for full prognostic information disclosure, all in the course of a fifteen minute consultation?
Adjust you diet to a whole-foods diet, exercise frequently, drink plenty of green tea, adjust your supplements with the help of a good dietician.
This writing is for informational purpose so you should go to see the doctor if the problem is severe. You also can take sprirulina capsule but make sure that you ask your doctor before using it. CLL is a disease of the elderly and not all of these patients are eligible for aggressive upfront chemo-immunotherapy regimens, so what is the optimal treatment approach for more frail elderly patients? This “Best Practices” paper pulls together all the important stuff we have learnt over the last decade and how it fits into your modern treatment game plan. For example, “bright” expression of a particular CD type (say, CD19) means there are many thousands of copies of CD19 present on each cell. The table below gives the fingerprint profiles of the various B-cell cancers.  Depending upon the sophistication of your testing lab all or only some of these CDs may be studied and reported. While 6 cycles of FCR is no walk in the park, the remissions are longer lasting than most other therapy regimens.
My dr is thinking chemo, but if it is my CLL acting up why shouldnt it show in my bloodwork?
It is highly likely that our treatment approaches will continue to evolve as the results of ongoing clinical trials are released and that further improvements in the outcome of this disease will result from identification of therapies that target the underlying pathophysiology of CLL.
A “dim” expression of CD20 for example means there are far smaller number of CD20 groups present per CLL cell. Anyway, your site is the most informative, and I really thank you for it, I wish my mom would have had something like this for her.
Think about whatSwelling In Neck.На шее штрихкод, Мика ньютон шей крылья облаков бесплатно.
Some labs use “+” for dim, “++” for intermediate and “+++” for bright expression of various CD clusters. MY father and brother both had prostate cancer so I figured I got it through the family line.
But i worked more than 20 years in an air traffic control center – exposed to radar radiation and electricity smog.
All of this turns into quite a full-time job once you put your mind to it and makes for a very pro-active approach.
If nothing else you will find that after a few months you will look and feel younger and healthier, which is a great thing to feel at any time but especially when you’re contending with a life-threatening disease. As long the research concentrates on a single impact factor, the longer it takes to find the clue for a proper approach in healing CLL and cancer in general. Around…The three major salivary glands are the parotid, submandibular andWhat are the Causes of Swollen Glands in the Neck?Шей лорен, Рисунки тату на шее.



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