By Guy B. Faguet
Veterans Affairs clinical heart, Augusta, GA. stories medical advances in molecular genetics and biology of power lymphocytic leukemia. Discusses the scientific elements, targeting analysis, diagnosis, remedies, and issues. additionally addresses familial and juvenile situations. DNLM: Leukemia, Lymphocytic, persistent.
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Extra resources for Chronic Lymphocytic Leukemia: Molecular Genetics, Biology, Diagnosis, and Management
PCR analysis allows chromosomal breakpoints to be identified. Comparative genomic hybridization, developed in 1992 (142), has the ability to survey the whole genome in a single hybridization and can detect and map relative DNA sequence copy number between genomes. It can distinguish changes as low as several kilobases up to as many as a few megabases. These techniques have identified a number of new chromosomal aberrations as well as previously known aberrations in previously normal-seeming cases.
The highrisk group, which combines Rai stages III and IV, is similar to Binet’s worst prognosis group, stage C. Binet’s stage A and Rai’s lowest group 0 are, however, not as similar. In 1988, Rai and Sawitsky (56) described the staging system of Jaksic and Vitale proposed in 1981 (57), which attempts to estimate the total tumor mass (TTM) of leukemic cells in CLL. The TTM score was further reviewed in 1999 by Rai and Han (59). The TTM is the sum of the square root of the ALC plus the diameter in centimeters of the largest lymph node plus the number of centimeters the spleen is below the left costal margin.
60) showed the prognostic value of the ALC in Rai stage I and II and in Binet stage A and B. Survival is shortened in both clinical stages when the ALC is greater than 50 × 109 cells/L. In 1987 Lee et al. (61), using a regression model as well as uric acid and lactate dehydrogenase (LDH) levels, were able to separate risk groups within a given clinical Rai stage, but this approach does not appear to have been widely used (61). In 1987 Mandelli et al. (62) drew attention to the ALC (> 60 × 109 cells/L) and the size of a given lymph node and spleen and likewise were able to improve on the present staging systems.