الفهرس 
I. IntroductionOnly 14 pages are availabe for public view
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Abstract
Chronic lymphocytic leukemia represents the most common leukemia among adults. It affects old patients more than youngs with male : female ratio of 1.5-2: 1.
Chronic lymphocytic leukaemia is defined as a lymphoproliferative disorder, composed by monomorphic round B lymphocytes involving peripheral blood, bone marrow and lymphoid organs.
There is a link between CLL and occupational and lifestyle factors with higher risk in farmers inspite of the protective role of sun. Also, there is a non-specific relation between HCV and CLL as HCV is associated with many lymph-proliferative diseases.
CLL has a genetic predisposition supported by several lines of evidence as most patients have a family history of hematological malignancies.
Diagnosis of CLL is done by immunophenotyping in a peripheral blood film and by lymph node biopsy or bone marrow aspirate/biopsy.
Deletion of the long arm of chromosome 13 is found in 50% of CLL cases and it is usually associated with favorable prognosis when isolated. Also, trisomy 12 is detected in 10-20% of cases was classified as an intermediate prognosis marker, in addition, deletion of the long arm of chromosome 11 is found in 5-20% of CLL patients.
The application of fluorescence in situ hybridization (FISH) technique demonstrated that genomic aberrations can be identified in more than 80% of CLL cases; in most cases they involve loss or gain of genetic materials while translocations are rare. During the past several decades, therapeutic options for CLL have evolved significantly. The advent of immunomodulating agents (eg, lenalidomide) and CD20 (rituximab, obinutuzumab, and ofatumumab) and CD52 (alemtuzumab) monoclonal antibodies have led to the development of effective chemoimmuno-therapy regimens. More recently, small molecule inhibitors targeting kinases involved in a number of critical signaling pathways (eg, Bruton tyrosine kinase [BTK], phosphatidylinositol 3-kinase [PI3K], and spleen tyrosine kinase) and a small molecule inhibitor of the BCL-2 family of proteins have shown promising activity in the treatment of patients with CLL.
Early-stage disease in some patients may have an indolent course and in others may progress rapidly to advanced disease requiring immediate treatment. Patients with low-risk CLL or intermediate-risk CLL may benefit from treatment if they become symptomatic or show evidence of progressive disease while patients with advanced-stage CLL with progressive cytopenia require treatment.
The standard treatment of patients with early disease is a watch-and-wait strategy due to the lack of clinical trials or evidence-based treatment recommendation.