Talk:Chronic lymphocytic leukemia

Covid and CLL
In the UK, Boris and co have announced the end of locking down by july 19th. There have been measures and special consideration for those who are extremely clinically vulnerable, which includes CLL sufferers.

A BBC report today here has a section in it, the last account on the page, about a double jabbed CLL victim having no covid antibodies hence remaining in a very vulnerable state.

I dont think this goes to the level of having to report this in the article, as I dont believe this ref to be reliable in our sense. But I am concerned that this may pan out into something much more concerning.

Any thoughts? -Roxy the grumpy dog . wooF 14:29, 6 July 2021 (UTC)

Queen's Medicine Class of 2025 - MEDS 112 CARL Wikipedia Initiative
Hello Wikipedia Community!

We are a group of 21 medical students from Queen's University and we will be working to make relevant edits and improvements to this article. We will be making edits such as adding good quality references, updating information that is out of date, and fixing spelling or grammar.

We will be making our edits within the next coming weeks.

Suggested edits:

Suggestions 1:
 * Adding current estimate for 2021 incidence in U.S.A. after global numbers in paragraph 4. Cmartypants (talk • contribs) 20:14, 15 November 2021 (UTC)
 * I suggest to update the age at which the disease most commonly occurs (according to the existing source used), and to add greater context about the increased risk of CLL with age.Proposed edit: “The disease most commonly occurs in people over the age of 65 due to the accumulation of genetic mutations that occurs over time." Torotking (talk) 22:25, 16 November 2021 (UTC)
 * Feedback: These look like good ideas. Can you be sure to include your citations as well? If you need to practice adding them please do it here or in your sandbox. JenOttawa (talk) 01:19, 26 November 2021 (UTC)

Suggestion 2:
 * Proposed deletion: “Rates of CLL are somewhat elevated in people exposed to certain chemicals. Under U.S. Department of Veterans Affairs regulations, Vietnam veterans who served in-country or in the inland waterways of Vietnam and who later develop CLL are presumed to have contracted it from exposure to Agent Orange and may be entitled to compensation.”
 * Proposed addition: “People who live near areas with considerable industrial pollution have an elevated risk of developing leukemia, particularly CLL” [citation: https://doi.org/10.1016/j.envint.2020.106090]. Dhunnasim2025 (talk • contribs) 20:21, 15 November 2021 (UTC)
 * Feedback: This looks great. Can you be sure to add your citation using the correct tool? I know that it is harder to do on the talk page (no visual editor), but please at least practice it in your sandbox so you know how to do it when we edit live on Monday. JenOttawa (talk) 01:22, 26 November 2021 (UTC)

Suggestion 3
 * Proposed deletion: Less commonly, CLL may present with enlarged lymph nodes.[9] This is referred to as small lymphocytic lymphoma.
 * Proposed addition: Less commonly, CLL may present with enlarged lymph nodes. [9] If enlarged lymph nodes are present and additionally, the peripheral blood concentration of B lymphocytes does not exceed 5.0x10^9 per L, a diagnosis of small lymphocytic lymphoma (SLL) is made rather than CLL. (reference : PMID 32735048, Kreuzberger N, Damen JA, Trivella M, et al. Prognostic models for newly-diagnosed chronic lymphocytic leukemia in adults: a systematic review and meta-analysis. Cochrane Database System Rev. 2020;7(7):CD012022. Published 2020 Jul 31. doe:10.1002/14651858.CD012022.pub2 )
 * JanYeezy (talk) 15:16, 19 November 2021 (UTC) JanYeezy
 * Feedback: This looks good. Is this evidence also from reference #9? If so you can re-use the same ref after your new sentence. If not, please include your reference. JenOttawa (talk) 01:31, 26 November 2021 (UTC)
 * Reply : I couldn't add the reference using the pubMED ID so I've just added the full reference on the talk for now and will add it in as a new reference when I modify the actual article. Please see in brackets above for reference as well as pubMED ID!
 * No problem, it is annoying (and definitely not your fault!) that the talk pgaes do not use the visual editor so it will look different then we practiced in class with the visual editor. When you are making your actual edit be sure to 'review' it carefully and check that all the fields are filled out and it appears the same as the other citations on the page. Testing adding with PMID. JenOttawa (talk) 02:49, 26 November 2021 (UTC)

Suggestion 4:
 * The following changes are recommended for the treatment section (third paragraph):
 * Revise the wording to the following and add a wikilink for chemoimmunotherapy: “In those with significant symptoms or active disease, chemotherapy, immunotherapy, or chemoimmunotherapy may be used”.
 * Add the following sentence: Depending on the individual’s age, physical condition, and whether they have the del(17p) or TP53 mutation, different first line treatments may be offered ”.
 * Revise the wording to the following, and add a wikilink for BTK, ibrutinib, and acalabrutinib: “As of 2021, BTK inhibitors such as ibrutinib and acalabrutinib are often recommended for first line treatment of CLL ”.
 * Thank you, NotJules (talk) 21:50, 18 November 2021 (UTC)
 * Feedback: These edits look great except make sure you add your references properly using the 'cite tool'. You can practice in your sandbox or flag me in class for help. Thanks! JenOttawa (talk) 01:32, 26 November 2021 (UTC)

Suggestion 5: I have proposed the following changes to the second paragraph to expand on the risk factors associated with CLL:
 * 1.	Revise the wording of the first sentence of the second paragraph to: Risk factors include having a family history of the disease, with 10% of those who develop CLL have a family history of the disease.
 * 2.	Revise the wording of the second sentence of the second paragraph to: Exposure to Agent Orange, certain insecticides, reduced recreational sun exposure, exposure to hepatitis C virus, and common infections are also considered risk factors.
 * Thanks, Sonuvarghese (talk) 21:54, 18 November 2021 (UTC)
 * These edits look good . Please add your reference as we learned in class when you do your actual edit on Wikipedia. Reach out in class if you are having trouble and practice in your sandbox. Thanks! JenOttawa (talk) 01:34, 26 November 2021 (UTC)

Suggestion 6:
 * 1. Adding “most commonly used in the United States” beside the Rai staging system sub header.
 * 2. Adding “most commonly used in Europe” beside the Binet classification sub header.
 * Thanks,Smoshi1996 (talk) 19:11, 18 November 2021 (ET)
 * Thanks for sharing this . When editing live on Wikipedia please make sure that all the fields are populated for your reference by using the cite tool that we practiced in class or adding it manually. example. JenOttawa (talk) 02:52, 26 November 2021 (UTC)

Suggestion 7:
 * 1. In the Epidemiology section, modify “CLL is primarily a disease of older adults, with a median age of 70 years at the time of diagnosis. Though less common, CLL sometimes affects people between 30 and 39 years of age. The incidence of CLL increases very quickly with increasing age.” to “CLL is primarily a disease of older adults, with 9 out of 10 cases occurring after the age of 50 years. The median age of diagnosis is 70 years. ”
 * 2. Also in the Epidemiology section, add “In young people, new cases of CLL are twice as likely to be diagnosed in men than in women. In older people, however, this difference becomes less pronounced: after the age of 80 years, new cases of CLL are diagnosed equally between men and women. ”
 * Please note that page numbers were not provided in either e-book. Kind regards, Hyperkarbia (talk) 14:42, 19 November 2021 (UTC)
 * Thanks for noting that page numbers are usually suggested for textbooks. With some e-books there are no page numbers so no problem! Great adding your reference properly as well  JenOttawa (talk) 02:56, 26 November 2021 (UTC)

Suggestion 9:
 * I have proposed the following edit to the section of refractory CLL.Instead of the sentences "In this case, more aggressive therapies, including lenalidomide, flavopiridol, and bone marrow (stem cell) transplantation, are considered.[61] The monoclonal antibody alemtuzumab (directed against CD52) may be used in patients with refractory, bone marrow-based disease." I would like to insert "In this case, more aggressive targeted therapies, such as BCR or BCL2 pathway inhibitors, have been associated with increased survival."
 * Thanks, Garretcvh (talk) 18:54, 19 November 2021 (UTC)
 * Feedback:This edit looks good. Are there any wikilinks that can be added to the targeted therapies? There is a problem that needs to be changed with how you referenced your citation. You cannot use your University library link (as others cannot access it) . By pulling your doi from the queen's link I have added it here. Please pay careful attention to this when you edit the article live. Citation. JenOttawa (talk) 02:56, 26 November 2021 (UTC)

Suggestion 10:
 * I propose the following changes to the differential diagnosis section: "" indicates an addition.
 * In the past, cases with similar microscopic appearance in the blood but with a T cell phenotype were referred to as T-cell CLL. However, these are now recognized as a separate disease group and are currently classified as T-cell prolymphocytic leukemias "(T-PLL)". "An accurate diagnosis of T-PLL is important as it is a rare and aggressive disease." "new source". Source: Sud, A., Dearden, C. (2017). T-cell prolymphocytic leukemia. Hematology/Oncology Clinics of North America, 31(2), 273-283.
 * Thanks,--Sjs1234567 (talk) 02:46, 20 November 2021 (UTC)
 * This looks good . Be sure to add your source as we practiced in class so that the fields are populated wikipedia-style. JenOttawa (talk) 03:00, 26 November 2021 (UTC)

Suggestion 11:
 * I propose to edit this sentence under the Diagnosis section of the article: “A peripheral blood smear showing an abundance of damaged cells known as smudge cells or smear cells can also indicate the presence of the disease (smudge cells are due to cancer cells lacking in vimentin, a cytoskeletal protein)”.
 * I am proposing the following change: “A peripheral blood smear showing an abundance of damaged cells known as smudge cells or smear cells can also indicate the presence of the disease (smudge cells are due to cancer cells lacking in vimentin, a type structural component in a cell which maintains the cell’s internal shape and mechanical resilience, a type of cytoskeletal protein)”.
 * Someone who had little to no science background may not understand the difference between cancer cells and normal cells described if there is no explanation of what ‘cytoskeleton’ is referring to. It could be critical for the person to understand these details of CLL per se if they have or someone close to them has recently been diagnosed. Developing a greater understanding of the difference between healthy cells versus cancer cells can allow the person to take part in medical conversations regarding the pathology of the disease and how it is affecting their body. Although a small change, enhancing a patient’s understanding of their disease allows them to take part in treatment decisions better and overall leads to greater autonomy over their care. The proposed change was developed using secondary resources found through a PubMed search. Thanks, Alexmacmaster (talk) 21:56, 19 November 2021 (UTC)
 * Thanks for sharing. Your class did a terrific job on the talk page here. Please be sure to include your citation in the actual edit (the same way that we practiced in class). . Nice work here! JenOttawa (talk) 03:03, 26 November 2021 (UTC)

Suggestion 12:
 * The following changes are recommended under the Decision to Treat section of the article: "" indicates change or addition.

Because of it's slow onset, "asymptomatic" early-stage CLL "(Rai 0, Binet A)" is, in general, not treated since it is believed that "early-stage" CLL intervention does not improve survival time or quality of life. Instead, the condition is monitored over time to detect a change in the disease pattern. "new reference" The decision to start CLL treatment is taken when "there is evidence for progressive symptomatic disease (summarized as "active disease")." Determining when to start treatment and by what means is often difficult; no survival advantage is seen in treating "people with asymptomatic early-stage CLL." The "National Working Group on CLL" has issued guidelines with specific markers that should be met "to initiate treatment." "new reference"

Source: Michael Hallek, Bruce D. Cheson, Daniel Catovsky, Federico Caligaris-Cappio, Guillermo Dighiero, Hartmut Döhner, Peter Hillmen, Michael Keating, Emili Montserrat, Nicholas Chiorazzi, Stephan Stilgenbauer, Kanti R. Rai, John C. Byrd, Barbara Eichhorst, Susan O’Brien, Tadeusz Robak, John F. Seymour, Thomas J. Kipps; iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood 2018; 131 (25): 2745–2760. doi: https://doi.org/10.1182/blood-2017-09-806398, Thanks, Swipahthefox (talk) 02:56, 20 November 2021 (UTC)
 * Thanks for the suggestion. The talk page only uses wikicoding so I realize that it is not the same as adding your citation with the visual editor. When you are making this edit live please include the citation properly with the fields populated as we practiced in class. JenOttawa (talk) 03:06, 26 November 2021 (UTC)

Suggestion 13:
 * The following changes are recommended under the epidemiology section at the start of the second paragraph:
 * Proposed deletion: "In the United States during 2014, about 15,720 new cases are expected to be diagnosed, and 4,600 patients are expected to die from CLL."
 * Proposed addition: "According to the American Cancer Society, in the United States, 13,040 males and 8,210 females (total of 21,250 people) are expected to be newly diagnosed with CLL in 2021. In that same year, 2,620 males and 1,700 females (total of 4,320 people) are expected to die from CLL."
 * Thank you,Butterbeerpls (talk) 01:45, 20 November 2021 (UTC)
 * Thanks for sharing this here. Please add this website using the tool (we practiced in class). Since it is a website you may need to add some fields manually. JenOttawa (talk) 03:07, 26 November 2021 (UTC)

Suggestion 14: The Research directions section could use updating, specifically the portion detailing chimeric antigen receptor T therapy. Following the 3rd paragraph, the following addition is proposed: "A 2019 study suggests that patients with CLL undergoing immunotherapy with | chimeric antigen receptor T cells have a high clinical response rate. "
 * Thanks,Qfarrar (talk) 01:57, 20 November 2021 (UTC)
 * Thank you for sharing this. I have a few suggestions to update how your sharing evidence from the systematic review that you cited (not an individual study). How do you feel about simplifying it and writing something like: People with CLL undergong immunotherapy with chimeric antigen receptor T cells have been found to have a high response rate. Note my use of "people" versus patients as well.  This is just an idea, please feel free to add your own ideas! Good work here! JenOttawa (talk) 03:15, 26 November 2021 (UTC)

Suggetion 15:
 * The following addition is proposed under the prognosis section:
 * Proposed addition: "In addition, sex has been found to have an impact on CLL prognosis and treatment efficacy. More specifically, females have been found to survive longer (without disease progression) than males, when treated with certain medications."
 * We suggest that these sentences are added after this existing sentence: "While prognosis is highly variable and dependent on various factors including these mutations, the average 5-year relative survival is 86.1%.[66] Telomere length has been suggested to be a valuable prognostic indicator of survival[67]."
 * Citation: Al-Sawaf, O., Robrecht, S., Bahlo, J. et al. Impact of gender on outcome after chemoimmunotherapy in patients with chronic lymphocytic leukemia: a meta-analysis by the German CLL study group. Leukemia 31, 2251–2253 (2017). https://doi.org/10.1038/leu.2017.221 —
 * Oc373 (talk) 02:12, 20 November 2021 (UTC) Pumpkinspice7 (talk) 02:58, 20 November 2021 (UTC)
 * Hi thanks for sharing this here. This looks good. Please be sure to add the reference properly (with all fields populated) as we practiced in class. Your citation will go immediately after your punction so it will look like this: In addition, sex has been found to have an impact on CLL prognosis and treatment efficacy. More specifically, females have been found to survive longer (without disease progression) than males, when treated with certain medications. JenOttawa (talk) 03:18, 26 November 2021 (UTC)

Suggestion 16:
 * I propose the following change to the Research directions section:


 * 1) Add/update the sentence regarding Syk inhibitors to read “Syk inhibitors fostamatinib and entospletinib are currently in trials”. [https://en.wikipedia.org/wiki/Chronic_lymphocytic_leukemia#cite_note-pmid25050922-81
 * 2) Remove “needs update” and add Wiki-link for “entospletinib”.
 * I propose changing the definition sentence in the Refractory CLL section from a “disease that no longer responds favorably to treatment” to a “disease that no longer responds favorably to treatment within 6 months following the last cancer therapy” .  H.azulu (talk • contribs) 20:45, 21 November 2021 (UTC)
 * Thanks for sharing these here good use of Wikilinks. Be sure to add both your citations using the tool. I am not sure why your citation has https://en.wikipedia.org/wiki/Chronic_lymphocytic_leukemia#cite_note-pmid25050922-81|[81]. I know it is more challenging to add citations here on the talk page as it does not use the visual editor that we practiced in class. Please make sure you are ready to add them correctly on Monday. I am also happy to help so please reach out if there are problems. JenOttawa (talk) 03:23, 26 November 2021 (UTC)

Suggestion 17:
 * Here is a list of our suggestions to the Chronic Lymphocytic Leukemia #Causes section:


 * Original Sentence 1: “CLL can also be caused by a number of epigenetic changes, which can be classified into 3 different methylation subgroups (naïve B-cell-like, memory B-cell-like, and intermediate).21”
 * Changed Sentence 1: “CLL can also be caused by a number of epigenetic changes, which are adaptations that add a tag to specific DNA sequences, rather than altering the sequence itself. In CLL, these changes can be classified into the addition of 3 different methyl subgroups (naïve B-cell-like, memory B-cell-like, and intermediate), which impact how much that DNA sequence is transcribed. [Jarosova et al, 2019]”
 * Original Sentence 2: “Men are about twice as likely to get CLL as women, and risk increases with age.[23] It is relatively rare among Asians.”
 * Changed Sentence 2: “CLL is the most common type of leukaemia in the Western world compared to non-Western regions such as Asia, Latin America, and Africa [Murthy et al. 2021]. It is observed globally males are twice as likely than females to acquire CLL [Murthy et al. 2021].”
 * Original Sentence 3: “Since there is no one single mutation that causes CLL in all cases, an individual’s susceptibility may be impacted when multiple mutations that increase the risk of CLL are co-inherited.[22] Up until 2014, very few of these mutations or significant “risk alleles” had been identified.[22]”
 * Changed Sentence 3: “Since there is no one single mutation that is associated with CLL in all cases, an individual’s susceptibility may be impacted when multiple mutations that are associated with an increase in the risk of CLL are co-inherited.[22] Up until 2020, 45 susceptibility loci have been identified. 93% of these loci are linked to the alteration of 30 gene expressions involved in immune response, cell survival, or Wnt signaling.[Delgado et al., 2020]”
 * Notgautham (talk) 20:16, 15 November 2021 (UTC)
 * Feedback: Great edits . Be sure to add your citations properly as we practiced in class. I can help on Monday if there are problems while using the visual editor. Talk pages only use the source based editing tool so it is a little different. Are there any wikilinks that may be helpful here as well?JenOttawa (talk) 03:23, 26 November 2021 (UTC)

Suggestion 18:
 * Exposure Epidemiology of CLL: Proposed deletion: “Rates of CLL are somewhat elevated in people exposed to certain chemicals. Under U.S. Department of Veterans Affairs regulations, Vietnam veterans who served in-country or in the inland waterways of Vietnam and who later develop CLL are presumed to have contracted it from exposure to Agent Orange and may be entitled to compensation.”
 * Proposed addition: “People who live near areas with considerable industrial pollution have an elevated risk of developing leukemia, particularly CLL” [citation: https://doi.org/10.1016/j.envint.2020.106090]. Dhunnasim2025 (talk) 20:23, 15 November 2021 (UTC)
 * Feedback:  This looks good. Please ensure you add your citation correctly with the tool (to auto-fill the citation information) as we practiced in class.JenOttawa (talk) 02:46, 26 November 2021 (UTC)

Suggestion 19:
 * Research directions - Proposed update


 * Proposed change # 1 Original sentence: “Research in 2008 is comparing different forms of bone marrow transplants to determine which patients are the best candidates and which approach is best in different situations.”
 * Proposed change: In light of new therapies such as targeted agents, the role of bone marrow transplants is decreasing. According to a Clinical Practice Guideline by Kharfan-Dabaja et al. Bone marrow transplants are not recommended as a front-line therapy, and only recommended in specific cases where front-line therapies have either failed or there is a lack of response to BCL-2 inhibitors.
 * Edit: Unfortunately the citation tool was not functioning properly, but the DOI's for each reference are above and link to the relevant articles. An attempt was made to add these references to the article page, however they have appeared at the very bottom as a new [1] and [2] and this will be corrected with guidance in the very near future.Wandrmore (talk) 22:24, 15 November 2021 (UTC)
 * No problem about this mistake. Editing the talk page is a little bit different because talk pages do not have the visual editor, you did really well! I have cleaned up your references and removed the accidentally added references from the bottom. I also made a suggestion above to simplify.JenOttawa (talk) 01:54, 16 November 2021 (UTC)

FISH acronym
Perhaps an explanation of what FISH stands for, and a link if possible please. — Preceding unsigned comment added by 2001:8003:1405:3F00:708E:CDF1:437B:7DD2 (talk) 21:30, 20 November 2023 (UTC)
 * Here is the link to the FISH article: Fluorescence in situ hybridization aka (FISH). I have added it to the article.Buster7 (talk) 11:06, 21 November 2023 (UTC)