1. Step 9
1.1. Review session 2
1.2. mechanism flow chart
1.3. 20 minutes
2. Step 10
2.1. Management
2.1.1. staging & prognosis
2.1.1.1. Rai staging system
2.1.1.1.1. Stage 0 — 150 months
2.1.1.1.2. Stage I — 101 months
2.1.1.1.3. Stage II — 71 months
2.1.1.1.4. Stages III and IV — 19 months
2.1.1.2. Binet staging system
2.1.1.2.1. Stage A — comparable to age-matched controls
2.1.1.2.2. Stage B — 84 months
2.1.1.2.3. Stage C — 24 months
2.1.1.3. other factors
2.1.1.4. male, del17, and early chemotherapy can worsen prognosis or doubling of cells in 1 year
2.1.1.5. depends on age, stage and patient overall health
2.1.2. treatment indications
2.1.2.1. weight loss more than 10 percent in 6 months, fatigue, night sweats, doubling of cells in less than 12 months, organomegaly
2.1.3. goals of treatment
2.1.3.1. control symtoms, monitoring patient state, control complications and increase in overall survival
2.1.4. treatment options
2.1.4.1. chemotherapy
2.1.4.1.1. prophylaxis method is not beneficial
2.1.4.1.2. indicated in stage 3 or 4
2.1.4.1.3. target replicating cells along with normal cell
2.1.4.1.4. can be followed by radiation therapy in some cases
2.1.4.1.5. fludarabine, cyclophosphamide and rituximab (FCR)
2.1.4.1.6. tumor lysis syndrome can cause metabolic imbalance which can cause renal faliure (but its mainly in acute cases)
2.1.4.1.7. nasuea and vomiting are common side effects
2.1.4.1.8. clinical trials might be a good option for termianlly ill patients
2.1.4.1.9. infections are common, so prophylaxis can be given (influenza and pnumococcal)
2.1.4.2. start with corticoseroids in early stages
2.1.4.3. in poor performane patient the aim is to control symptoms by less agressive chemo and in case of co-morbidity a single chemo agent can be given
2.1.4.4. alemtuzumab
2.1.4.4.1. monoclonal antibody that binds to cd52 thyat can be given with the FCR combination
2.1.4.5. SCT
2.1.4.5.1. curative not pallitive
2.1.4.5.2. allogenic
2.1.4.5.3. addition of alemtuzumab to prevent graft versus host disease
2.1.4.6. radiotherapy
2.1.4.6.1. can be used for organomegaly
2.1.4.7. immunoglobulin can be given for hypogammaglobulinemia