NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia

10 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2019 1  CLL basics Rai stages Protein tests The abnormal B cells will be tested for surface proteins. This is called immunophenotyping. CLL cells have a certain pattern of proteins in their membrane. See Figure 3 . Rule out Mantle cell lymphoma needs to be ruled out. This lymphoma is closely related to CLL. Its cells have high levels of proteins called cyclin D1 that are caused by abnormal chromosomes. A cytospin machine may be used to test for cyclin D1. Protein tests of CD200 and LEF1 may also be useful. FISH ( f luorescence i n s itu h ybridization) is a lab test that may be done to test for abnormal chromosomes. Rai stages A cancer stage is a rating by your doctor that suggests the outcome of the cancer. It is also used to decide if treatment is needed now. Read Part 2 for more information on starting treatment. The Rai staging system is commonly used for CLL. It consists of five cancer stages: † † Stage 0 is defined by normal test results except for a high lymphocyte count. The likelihood of the cancer getting worse is low. † † Stage I is defined as a high lymphocyte count and enlarged lymph nodes. The likelihood of the cancer getting worse is intermediate. † † Stage II is defined by an enlarged liver, spleen, or both. The likelihood of the cancer getting worse is intermediate. † † Stage III is defined by a low hemoglobin level. Hemoglobin is a protein in red blood cells. The likelihood of the cancer getting worse is high. † † Stage IV is defined by a low platelet count. The likelihood of the cancer getting worse is high. You may hear of the Binet staging system. It is another system used to stage CLL. It has three Figure 3 CD20 protein CLL cells have a common pattern of proteins in their membrane. This pattern includes the presence of CD5, CD19, and CD23 proteins, some CD20, and no CD10 proteins. Immunophenotyping is the process of identifying the proteins in cells’ membranes. Derivative work of NIAID - Rituxima Binding to CD20 on a B Cell Surface, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=39933221

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