What Is Atypical CLL?

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Topics include: Understanding

Dr. William Wierda, a world-renowned CLL expert from MD Anderson Cancer Center in Houston, defines atypical CLL, how this diagnosis is determined, and how it relates to the standard features of CLL.

The Ask the Expert series is sponsored through an educational grant to the Patient Empowerment Network from Pharmacyclics, Inc.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Jeff Folloder:

Dr. Wierda, what is atypical CLL?

Dr. Wierda:

So atypical CLL is a term that's used when we have diagnostic information for a patient that doesn't fit all of the standard criteria and standard features of CLL.  Predominantly it relates the flow cytometry.  So flow cytometry is a laboratory technique or tool that we have that allows us to identify different proteins on the surface of cells.

CLL has a signature protein, signature protein constellation.  There are several proteins on the surface of CLL cells that allow us to say this is a CLL cell.  People probably are familiar with some of them. CD5, CD19, CD23, those are the big three that we look for as well as light chain on the surface of the cells that distinguish those cells from normal B cells and distinguish those non-normal B cells as CLL cells.

Atypical CLL may be a term that's used if a patient doesn't have those markers or proteins on the surface of the cells, that is typical or diagnostic for CLL.  For example, they may not have CD23 on the surface of the cell.  They may have CD5, CD19 and either kappa or lambda light chain but lower levels or don't—not CD23, that case would be referred to as atypical CLL.

Another feature—and there are other examples of proteins that may or may be present that would put a patient into that atypical category as opposed to standard CLL with the standard markers that we look for.

Another feature that may be associated with atypical CLL is that some patients' leukemia cells will produce a protein, an antibody.  It's not a normal antibody because there's too much of the same individual antibody, and so that's referred to as a paraprotein, and it's not typical for patients with CLL to have CLL cells that produce this protein.  And if we do identify patients who have this production and have a high level of protein in their blood that we can identify as being from their leukemia cells, those are also cases that we've referred to as atypical, because it's something that happens. It's rare, but it's not a normal or typical feature of CLL that we usually see.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on March 22, 2016