క్రానిక్ లింపోసైటిక్ లుకేమియా: కూర్పుల మధ్య తేడాలు

→‎నిర్ధారణ: లో ఆధారాలు చేర్చబడ్డాయి.
పంక్తి 58:
* ''చికిత్స దశ B '': రాయ్ I,II దిశలు.
* ''చికిత్స దశ C '': రాయ్ III,IV దిశలు.
<ref>{{cite journal | authors = Binet JL, Auquier A, Dighiero G, Chastang C, Piguet H, Goasguen J, Vaugier G, Potron G, Colona P, Oberling F, Thomas M, Tchernia G, Jacquillat C, Boivin P, Lesty C, Duault MT, Monconduit M, Belabbes S, Gremy F | title = A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. | journal = Cancer | volume = 48 | issue = 1 | pages = 198–206 | date = Jul 1, 1981 | pmid = 7237385 | doi = 10.1002/1097-0142(19810701)48:1<198::aid-cncr2820480131>3.0.co;2-v }}</ref>వ్యాధిని నిర్దారించే పద్దతి బట్టి రోగనిరూపణ ఆధారపడిఉంటది. రెండు <ref name="pmid11733578">{{cite journal | authors = Rosenwald A, Alizadeh AA, Widhopf G, Simon R, Davis RE, Yu X, Yang L, Pickeral OK, Rassenti LZ, Powell J, Botstein D, Byrd JC, Grever MR, Cheson BD, Chiorazzi N, Wilson WH, Kipps TJ, Brown PO, Staudt LM | title = Relation of gene expression phenotype to immunoglobulin mutation genotype in B cell chronic lymphocytic leukemia | journal = J. Exp. Med. | volume = 194 | issue = 11 | pages = 1639–47 | year = 2001 | pmid = 11733578 | pmc = 2193523 | doi = 10.1084/jem.194.11.1639 }}</ref> లేదా మూడు <ref name="pmid12406914">{{cite journal | authors = Ghia P, Guida G, Stella S, Gottardi D, Geuna M, Strola G, Scielzo C, Caligaris-Cappio F | title = The pattern of CD38 expression defines a distinct subset of chronic lymphocytic leukemia (CLL) patients at risk of disease progression | journal = Blood | volume = 101 | issue = 4 | pages = 1262–9 | year = 2003 | pmid = 12406914 | doi = 10.1182/blood-2002-06-1801 }}</ref>రోగనిరూపణలు చెడిపోయిన కణాల బట్టి నిర్దేశిస్తారు. ఈ తేడా ని కణాల పెరుగుదల బట్టి ఉంటది.<ref name="pmid16983131">{{cite journal | authors = Shanafelt TD, Byrd JC, Call TG, Zent CS, Kay NE | title = Narrative review: initial management of newly diagnosed, early-stage chronic lymphocytic leukemia | journal = Ann. Intern. Med. | volume = 145 | issue = 6 | pages = 435–47 | year = 2006 | pmid = 16983131 | doi = 10.7326/0003-4819-145-6-200609190-00007 | url = http://www.annals.org/cgi/content/full/145/6/435 }}</ref> ఎక్కువ ప్రమాదం ఉన్న మనుషులలో, సరిగ్గా లేని కణాల వరస సంభవిస్తుంది.<ref>{{cite journal | authors = Hamblin TJ, Davis Z, Gardiner A, Oscier DG, Stevenson FK | title = Unmutated Ig V(H) genes are associated with a more aggressive form of chronic lymphocytic leukemia | journal = Blood | volume = 94 | issue = 6 | pages = 1848–54 | year = 1999 | pmid = 10477713 | url = http://bloodjournal.hematologylibrary.org/cgi/content/full/94/6/1848 }}</ref> కొన్ని ఉపజన్యులు వాడటం వలన రోగనిరూపణ కచ్చితంగా చెయ్యవచు.<ref>{{cite journal | authors = Tobin G, Thunberg U, Johnson A, Thörn I, Söderberg O, Hultdin M, Botling J, Enblad G, Sällström J, Sundström C, Roos G, Rosenquist R | title = Somatically mutated Ig V(H)3–21 genes characterize a new subset of chronic lymphocytic leukemia | journal = Blood | volume = 99 | issue = 6 | pages = 2262–2264 | year = 2002 | pmid = 11877310 | doi = 10.1182/blood.V99.6.2262 }}</ref> IG యొక్క వేరువేరు ఉపజన్యుల రూపము బట్టి దీర్ఘకాలిక కణాల స్వభావమును చెప్పవచ్చు అని నమ్ముతారు.<ref>{{cite journal|pmid=25080849|doi=10.1111/ejh.12427|year=2015|author1=Seda|first1=V|title=B-cell receptor signalling and its crosstalk with other pathways in normal and malignant cells|journal=European Journal of Haematology|volume=94|issue=3|pages=193–205|last2=Mraz|first2=M}}</ref>ప్రమాదం తక్కువుగా ఉన్న వ్యాధిగ్రస్థులు లో DNA పరివర్తనము చూడవచును.<ref name="pmid10477713">{{cite journal | authors = Hamblin TJ, Davis Z, Gardiner A, Oscier DG, Stevenson FK | title = Unmutated Ig V(H) genes are associated with a more aggressive form of chronic lymphocytic leukemia | journal = Blood | volume = 94 | issue = 6 | pages = 1848–54 | year = 1999 | pmid = 10477713 | url = http://bloodjournal.hematologylibrary.org/cgi/content/full/94/6/1848 }}</ref> కొన్ని ఇతర కాండములు ఉపయోగించడం వలన కూడా సూక్ష్మ RNA కి సంబందించబడతాయి.<ref>{{cite journal | authors = Mraz M, Dolezalova D, Plevova K, Stano Kozubik K, Mayerova V, Cerna K, Musilova K, Tichy B, Pavlova S, Borsky M, Verner J, Doubek M, Brychtova Y, Trbusek M, Hampl A, Mayer J, Pospisilova S | title = MicroRNA-650 expression is influenced by immunoglobulin gene rearrangement and affects the biology of chronic lymphocytic leukemia | journal = Blood | volume = 119 | issue = 9 | pages = 2110–2113 | year = 2012 | pmid = 22234685 | pmc = | doi = 10.1182/blood-2011-11-394874 }}</ref><ref name="ReferenceA">{{Cite journal | last1 = Mraz | first1 = M. | last2 = Stano Kozubik | first2 = K. | last3 = Plevova | first3 = K. | last4 = Musilova | first4 = K. | last5 = Tichy | first5 = B. | last6 = Borsky | first6 = M. | last7 = Kuglik | first7 = P. | last8 = Doubek | first8 = M. | last9 = Brychtova | first9 = Y. | last10 = Mayer | doi = 10.1016/j.leukres.2013.03.018 | first10 = J. | last11 = Pospisilova | first11 = S. | title = The origin of deletion 22q11 in chronic lymphocytic leukemia is related to the rearrangement of immunoglobulin lambda light chain locus | journal = Leukemia Research | volume = 37 | issue = 7 | pages = 802–808 | year = 2013 | pmid = 23608880 | pmc = }}</ref>80 శాతం మందిలో అర్రే-CGH ద్వారా జన్యు మార్పులు గమనించవచ్చు.<ref name="pmid16983131" /><ref name="ReferenceA"/><ref>{{cite journal | authors = Mraz M, Malinova K, Kotaskova J, Pavlova S, Tichy B, Malcikova J, Stano Kozubik K, Smardova J, Brychtova Y, Doubek M, Trbusek M, Mayer J, Pospisilova S | title = MiR-34a, miR-29c and miR-17-5p are downregulated in CLL patients with TP53 abnormalities | journal = Leukemia | volume = 23 | issue = 6 | pages = 1159–1163 | year = 2009 | pmid = 19158830 | pmc = | doi = 10.1038/leu.2008.377 }}</ref>
ప్రామాణిక CLL ఫిష్ ప్యానెల్ లో > 95% కన్జోర్డాన్స్ ఉన్నాయని అనేక క్లినికల్ ధ్రువీకరణ అధ్యయనాలు చుపించాయి.
 
<ref>{{cite journal | authors = Lehmann S, Ogawa S, Raynaud SD, Sanada M, Nannya Y, Ticchioni M, Bastard C, Kawamata N, Koeffler HP | title = Molecular allelokaryotyping of early-stage, untreated chronic lymphocytic leukemia | journal = Cancer | volume = 112 | issue = 6 | pages = 1296–305 | date = March 2008 | pmid = 18246537 | doi = 10.1002/cncr.23270 }}</ref><ref>{{cite journal | authors = Sargent R, Jones D, Abruzzo LV, Yao H, Bonderover J, Cisneros M, Wierda WG, Keating MJ, Luthra R | title = Customized oligonucleotide array-based comparative genomic hybridization as a clinical assay for genomic profiling of chronic lymphocytic leukemia | journal = J Mol Diagn | volume = 11 | issue = 1 | pages = 25–34 | date = January 2009 | pmid = 19074592 | pmc = 2607562 | doi = 10.2353/jmoldx.2009.080037 | url = http://linkinghub.elsevier.com/retrieve/pii/S1525-1578(10)60205-X }}</ref><ref>{{cite journal | authors = Schwaenen C, Nessling M, Wessendorf S, Salvi T, Wrobel G, Radlwimmer B, Kestler HA, Haslinger C, Stilgenbauer S, Döhner H, Bentz M, Lichter P | title = Automated array-based genomic profiling in chronic lymphocytic leukemia: development of a clinical tool and discovery of recurrent genomic alterations | journal = Proc. Natl. Acad. Sci. U.S.A. | volume = 101 | issue = 4 | pages = 1039–44 | date = January 2004 | pmid = 14730057 | pmc = 327147 | doi = 10.1073/pnas.0304717101 }}</ref><ref>{{cite journal | authors = Pfeifer D, Pantic M, Skatulla I, Rawluk J, Kreutz C, Martens UM, Fisch P, Timmer J, Veelken H | title = Genome-wide analysis of DNA copy number changes and LOH in CLL using high-density SNP arrays | journal = Blood | volume = 109 | issue = 3 | pages = 1202–10 | date = February 2007 | pmid = 17053054 | doi = 10.1182/blood-2006-07-034256 }}</ref><ref>{{cite journal | authors = Gunn SR, Mohammed MS, Gorre ME, Cotter PD, Kim J, Bahler DW, Preobrazhensky SN, Higgins RA, Bolla AR, Ismail SH, de Jong D, Eldering E, van Oers MH, Mellink CH, Keating MJ, Schlette EJ, Abruzzo LV, Robetorye RS | title = Whole-genome scanning by array comparative genomic hybridization as a clinical tool for risk assessment in chronic lymphocytic leukemia | journal = J Mol Diagn | volume = 10 | issue = 5 | pages = 442–51 | date = September 2008 | pmid = 18687794 | pmc = 2518739 | doi = 10.2353/jmoldx.2008.080033 }}</ref>
<ref>{{cite journal | authors = Mraz M, Malinova K, Kotaskova J, Pavlova S, Tichy B, Malcikova J, Stano Kozubik K, Smardova J, Brychtova Y, Doubek M, Trbusek M, Mayer J, Pospisilova S | title = MiR-34a, miR-29c and miR-17-5p are downregulated in CLL patients with TP53 abnormalities | journal = Leukemia | volume = 23 | issue = 6 | pages = 1159–1163 | year = 2009 | pmid = 19158830 | pmc = | doi = 10.1038/leu.2008.377 }}</ref>
 
==చికిత్స==