Talk:Chronic lymphocytic leukemia/Archive 1

Question
Question on disease classification:

It mentions that CLL is proliferation of B-cells, and that the so-called T-cell CLL is now understood to be another disease group - how about the third type, NK-cells (natural killer cells) -- is NK-cell CLL more like B-cell CLL or the new type of T-cell disease mentioned in the article?

- Deniz

--

Q: "I would like to know the life span of chronic Lymphocytic Leukemia?"

I think that's a tough question to get at because there's a wide range. I wish I knew.

Who am I? I'm the first contributor, otherwise known as IP address 68.169.185.49. My wife was diagnosed with CLL in 1999... and I finally worked up the gumption to post a wiki about it, mistakes and all, in feb 2004, not long after she was treated for first time using the FCR protocol. She's since been treated twice since then with rituximab. So she's 7 years post diagnosis and right now doing well (she's 50 now, relatively young for a CLL patient). Not sure how many times Rituxan is going to to the trick for her or if she'll be able to tolerate it (she's had some Stevens-Johnson syndrome problems.) Also not sure what the next step will be for her.

Anyway, my aim then was to provide a short piece that touched on the key things a new CLL patient is likely to encounter, in not-too-complex language. I figured there's plenty of scholarly writing about CLL out there for the Googling and linking-in for people who want to be amateur hematologists (as seems the fate of CLL patients and their families) without snowing them under with all the molecular biology detail.

So when I came back and looked at the article today came away with the feeling that the article has become become too technical right off the top. I have specific issue with "Risk Stratification" (wha?) - that's a horrible paragraph that doesn't fit with the rest of the body. I may have a crack at this one soon if someone doesn't fix it.

So my simple plea to you hematologists out there: really, really resist the urge to indulge in jargon or highly technical detail. I know it's important in your work, but I think it's out of place for a basic wiki like this.

thanks -

- mister slack

p.s. - did I answer your question?

--

This is a good point - the wiki serves the need of patients and students alike, and all articles implicitly assume some degree of previous knowledge, sometimes it is hard to know where to stop. I think though that the general page should be jargon-free, with links to more in depth articles within Wikipedia for each section (a little like how they do the pages for countries - a seperate page for economics, demographics, military etc. with the general article not overwhelming the reader).

Autoimmunity
Article - pernicious anaemia is only autoimmune condition that increases risk, while rheumatic heart disease decreases risk. JFW | T@lk  22:06, 21 June 2006 (UTC)

I know a man who was diagnosed in 1977 and was in his early 50's at the time. As of January 2007 he is stll alive and is doing well for a man in his 80's. He has been treated with chemo numerous times.

In his own words: "A lot has happened since I started with a Dr's first words that I had Leukemia and he thought I had about 3 mo's to live. A visit to a specialist and more tests gave me my CLL diagnosis and a lot more hope. As I am now 81 you can see that what you are asking involves years of blood tests and Doctor visits that still go on every three or so months.One thingIhave always had is my faith that all will be well. My ups and downs mentally I have always tried to keep to myself. My condition has been always known to family and friends and to this day can be the subject of questions and conversations.

I find that Doctors have different opinions on which way to treat CLL and even at this stage of life there are decisions to be made on what to do.

My recent visit to the Moffitt Cancer center in Tampa, Fl. where the Dr said you are a lucky one and I don't recommend changing a thing unless there is a sudden change for the worse.There are a lot of new drugs and I never know how they are going to react with different individuals. They could make things worse .I had gone there as my Fla Dr wanted to give me aggressive Drugs to try and wipe out the disease. I don't go to him any more. I would say to you that unless they make new discoveries you will be with CLL for the rest of your life and briefly I say don't let it bother you. I have done always what I have wanted to ,fortunately the Chemo I have taken didn't bother me and when I stopped it the changes were not dramatic.

I suspect that I am on the edge of starting chemo again but that doesn't bother me much.

My first Dr, when I asked him how long I had ,said did you see that man who just left he has CLL and is 90 years old. Just think that could be you."

Yes, that will be me. I am 42 and have a subset of CLL with an excellent prognosis.

72.145.177.118 02:51, 27 January 2007 (UTC)

Auto Immunity an unknown
Staffordshire Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, U.K.

There is evidence for an increased incidence of lymphoproliferative disorders in patients with rheumatoid arthritis (RA). We present the clinical features of 4 patients with RA and chronic lymphatic leukaemia (CLL) which, occurring in a population of 1505 RA patients, represents a significantly increased prevalence of CLL (p less than 0.05) compared to the general population. These patients had significantly lower natural killer cell activity than matched rheumatoid controls (p less than 0.05) or normal controls (p less than 0.01) and we discuss this as a possible mechanism of association.

Chronic Lymphocytic Leukemia (CLL) is a subgroup of Chronic Lymphoid Leukemias. Chronic Lymphoid Leukemias inculdes many different types of leukemia, like CLL, PLL, HCL, Sezary, ATLL, LGLL...Crystal0619 01:05, 11 March 2007 (UTC)

Too Tecnical for a General Audience
My uncle was just diagnosed with CLL, so of course I googled "CLL" to find information. This article comes up second on the google search, and the disambiguation page for "CLL" comes up third. Its google rank is likely an indication that this is an article people are reading to get information after their loved one, friend, self etc. receives a diagnosis of CLL. Keep in mind that the laymen that will be reading this, like myself, may be in an emotional state after hearing the diagnosis; thus, it is especially important that this article is well organized and accessible.

Many of the technical terms need links to existing articles. As written, the article seems more geared toward the medical community. There is a ton of useful info here, but little of it will make any sense to the layman. Can we strike a balance? --JenniferOlivia 03:27, 11 April 2007 (UTC)

Balance
There needs to be a balance between the technical and general information aspects of this article. As it appears now, I don't believe it is very useful to the new CLL patient, or to the student who is checking out Wikipedia for a "first look" in their research. Since this is the most common form of leukemia, I think the article deserves a technical spin. A few of the wonderful hematologists and oncologists out there could help this article out a lot...and give us a look at the disease that they think would be useful to their patients and to their colleagues in general practice.

My dad succumbed to CLL just 4 years after diagnosis at age 53. I understand the original author's concerns, but for CLL support and general information, the Leukemia & Lymphoma Society, or Web MD would be my first stops.

Suggestions: Could someone discuss the genesis of B cells in the bone marrow, and what seems to make the stem cells go haywire? Are the different chromosomal deletions the result of "sloppy separation" during crossing over or mitosis? Is there a genetic predisposition evident, or is it random or environmental?

Last, (out of pure curiosity), could there be a connection with alpha 1 antitrypsin deficiency?

Rotkopf1Rotkopf1 00:16, 31 July 2007 (UTC)

Br J Haem
This month's Br J Haem has an entire issue full of free papers on the subject of CLL alone! Link JFW | T@lk  01:59, 23 November 2007 (UTC)

My Experience and View of the Subject
I have had CLL since 1992 and am probably not your average reader. There is nothing here that is difficult for me to understand. I find the information well organized and appropriate. It is better information than many Oncologist possess, that is unless they are a specialist. In most cases, a CLL patient should seek out a CLL specialist for treatment and then be followed up by a Hematologist/Oncologist. It does take time and work to reach the level of understanding that is presented here but it should be the goal of every CLL patient to become that well informed. Learning that one has CLL is one gigantic show stopper but it is very empowering to have the knowledge presented in this article when dealing with this disease. With this knowledge one can participate in the decision making process, whether it be watch and wait, a treatment regime or a clinical trial. I would suggest changing the sentence about needing treatment based on high white counts. Knowledgeable Oncologist never treat high counts but follow the recommendations of the NCI and/or using one of the two staging methods mentioned in the article. I would be pleased to share with anyone who has questions regarding CLL. --Jim Lawson 02:44, 8 December 2007 (UTC)

External links redux
Sorry, I didn't have this page on my watchlist. Yes, of course I object. Wikipedia's external links policy and the specific guidelines for medicine-related articles do not permit the inclusion of external links to non-encyclopedic material, particularly including internet chat boards and e-mail discussion groups. Because I realize that most normal editors haven't spent much time with these policies, please let me provide specific information from the guidelines:


 * This page, which applies to all articles in the entire encyclopedia, says that links "to social networking sites (such as MySpace or Fan sites), discussion forums/groups (such as Yahoo! Groups), USENET newsgroups or e-mail lists" are to be avoided.


 * This page deprecates ""helpful" external links, such as forums, self-help groups and local charities."


 * This medical-specific page reinforces the pan-Wiki rules, with a note that "All links must meet Wikipedia's external links guidelines, which in particular exclude discussion forums."

Wikipedia is an encyclopedia, and while it may occasionally be useful to patients or their families, it is not an advertising opportunity for support groups. Please do not re-insert links that do not conform to the standard rules. Any editor, BTW, is welcome to read all of the rules and perform an "audit" in the remaining links. Thanks, WhatamIdoing (talk) 21:22, 16 April 2008 (UTC)


 * My opinion is all or none. So I have placed The CLL Forum back on external links. This is not a chat site or discussion forum. It is an encyclopedic resource with over 2.5 million page views. CLL is a rare cancer - please allow us who are living with this incurable disease some latitude. —Preceding unsigned comment added by Steve Madden (talk • contribs) 21:56, 28 June 2008 (UTC)


 * Lymphomation.org is hardly one of the most comprehensive resources for CLL, it is barely used by CLL patients, and therefore I have removed the link. Several of the links that have been removed (discussions above) are of far greater value to patients than this one. If the point of Wikipedia is to have "politically correct" links, they should at least be of equal or greater value than the "politically incorrect" links that have been removed. —Preceding unsigned comment added by Lymphomaniac (talk • contribs) 19:39, 2 July 2008 (UTC)


 * I have no objection to removing Lymphomation.org. However, the standard for evaluating external links is not their popularity with patients.  It is their utility to the general reader -- a hypothetical person that is specifically neither a patient nor a professional.  WhatamIdoing (talk) 16:42, 5 July 2008 (UTC)

Deleted UCSD protocol
I deleted the reference to the UCSD protocol http://www.eurekalert.org/pub_releases/2008-02/uoc--gtp021108.php because it's just basic research, and they haven't demonstrated that there's any benefit to it (although it is newsworthy that it's in human trials). If you went to the ASCO web site and looked at their annual meeting you'd find hundreds of studies like this. We don't have room for them all. It might be worth discussing how to deal with basic research like this, but I don't think it belongs in this article. Nbauman (talk) 01:17, 12 February 2008 (UTC)

New guideline
There is a new guideline: JFW |  T@lk  20:19, 22 June 2008 (UTC)

The Epidemiology section is incorrect. see http://bloodjournal.hematologylibrary.org/cgi/content/abstract/100/2/635

Would the contributor consider changing ths? —Preceding unsigned comment added by Steve Madden (talk • contribs) 22:30, 28 June 2008 (UTC)

Disease "of the elderly"
Under Epidemiology I have changed "CLL is a disease of the elderly" to "CLL is a disease of older adults." "Elderly" is a relatively nonspecific term; many CLL patients would not be considered elderly but nearly all would be considered "older adults." Lymphomaniac (talk) 20:02, 2 July 2008 (UTC)

No longer T-cell?
What's the authority for saying that "so-called" T-cell CLLs are a separate disease group (and not a subset of CLL)? Who recognizes it?

eMedicine still considers T-cell CLL as CLL as of October 2008. eMedicine Chronic Lymphocytic LeukemiaApproximately 2-5% of patients with chronic lymphocytic leukemia (chronic lymphoid leukemia, CLL) exhibit a T-cell phenotype.

Is this a consensus or is this still under debate? Is it something that the broad oncology community agrees on, or is there a different perspective among sub-specialties or disciplines? How do you reconcile this with the eMedicine authors? Nbauman (talk) 18:43, 3 February 2009 (UTC)
 * It is the consensus of the National Institutes of Health and the World Health Organization's ICD-O. Please note the difference between (the 2007 version) and  (the 2009 version). Per the latter link, T-cell prolymphocytic leukemia is "A lymphoid leukemia characterized by a profound LYMPHOCYTOSIS with or without LYMPHADENOPATHY, hepatosplenomegaly, frequently rapid progression, and short survival. It was formerly called T-cell chronic lymphocytic leukemia." --Arcadian (talk) 18:27, 4 February 2009 (UTC)
 * I noticed the fact tag you added, so I've added a ref: "In 1989, the French-American-British (FAB) Cooperative Group distinguished five subgroups of T cell leukemia, namely, T cell CLL, T cell PLL, human T lymphotropic virus type I-positive (HTLV-I+), adult T cell leukemia/lymphoma, and Sézary syndrome. 640   When a new entity called large granular lymphocytic leukemia was defined (see Chap. 94), the existence of T cell CLL as a distinct entity became a topic of debate.  641,642,643,644  Because of this finding, the World Health Organization commissioned a panel of experts to draft a new classification of the hematologic neoplasms.  645  At a meeting in November 1997, the panel proposed a categorization of peripheral T cell neoplasms that largely was based on the Revised European-American Lymphoma (REAL) classification (see Chap. 90).  646  However, because of its aggressive clinical behavior, T cell CLL was reclassified under the heading of T cell PLL, without regard to subtle differences in morphology.  647   Even together they account for less than 5 percent of all chronic lymphoid leukemias." --Arcadian (talk) 18:40, 4 February 2009 (UTC)


 * I think that part of the confusion arises from the historical division of all leukemias into four groups. Once upon a time, if you had a leukemia that was chronic and involved lymphocytes, then you had "Chronic Lymphocytic Leukemia" -- considered a specific disease entity instead of a description of its characteristics.  It's like people saying that they're tired all the time, so they have Chronic Fatigue Syndrome, when they might have any one of dozens of other diseases that just happen to present with fatigue.  WhatamIdoing (talk) 19:06, 5 February 2009 (UTC)

Causes?
I just noticed that this article doesn't address the causes of CLL. It seems a little odd. Anyone have a favorite source? WhatamIdoing (talk) 03:11, 26 June 2009 (UTC)


 * There is no specific cause for CLL. Genetic abberations such as translocations lie at the root of all forms of cancer, and CLL is no exception. I'm sure there are theories... JFW | T@lk  19:39, 24 September 2009 (UTC)


 * There are a few chemicals like Agent Orange and some poorly described (but obviously present) genetic predispositions, but the fact that the cause isn't known should probably be addressed. I think that readers will want to "know what's not known" for the most common form of leukemia.  Also, it would be a good place to identify what's been ruled out (e.g., radiation).  WhatamIdoing (talk) 20:01, 24 September 2009 (UTC)


 * We could have a Causes and Risk factors subsection maybe in the epidemiology section. Rod57 (talk) 18:09, 28 June 2010 (UTC)


 * one word: Oncogene — Preceding unsigned comment added by 41.34.31.194 (talk) 07:05, 13 August 2011 (UTC)


 * There are no translocations in CLL, its an exception with that respect. However, there are some genetic aberrations that are very common, i.e. loss of a critical region in chromosomal band 13q14 that occurs in more than 50% of patients . If you remove that region in mice, they get a CLL-like disease, speaking in favor of that region to be important in developing the disease. — Preceding unsigned comment added by Aimee Anouk (talk • contribs) 15:05, 16 May 2013 (UTC)

HSCT
Blood - review of indications for allogeneic stem cell transplantation. JFW | T@lk  19:39, 24 September 2009 (UTC)

Cell size
Does anyone know offhand whether this change is correct? It 'feels right' to me, but my brief search didn't produce a source that addresses this issue, and I don't know. WhatamIdoing (talk) 17:50, 28 September 2009 (UTC)
 * It's not a full answer, but is a good start. --Arcadian (talk) 23:27, 28 September 2009 (UTC)
 * So B-CLL cells are smaller than any other leukemic cell... but I didn't see any clear comparison to normal lymphocytes in my (very) quick scan. It's a start, though:  at least it's not likely to be wildly inaccurate. WhatamIdoing (talk) 06:25, 29 September 2009 (UTC)

Research and Clinical trials
Could we have a section in/near Treatment mentioning any treatments undergoing late stage clinical trials that may be recruiting patients or nearing marketing approval ? Rod57 (talk) 00:25, 25 March 2010 (UTC)


 * Kind of yes, and kind of no.
 * A section titled something like "Research directions", that provides readers with a balanced summary of all B-CLL research would be an excellent thing. A section on "Investigational New Drug trials patients should sign up for" would be extremely unencyclopedic and unbalanced.
 * We don't want to promote clinical trials or to provide information that is really only interesting to patients (see WP:MEDMOS), but we do want to let people know how much work is done on this disease. I think that a section that shows the whole scope of research efforts (e.g., causes, epidemiology, prognosis, generic drugs, and non-drug treatments, as well as new drugs) would be very appropriate.
 * Do you have any good sources for such a section? WhatamIdoing (talk) 00:47, 25 March 2010 (UTC)


 * No, I was hoping others would. I agree we shouldn't be promoting clinical trials. I mention late stage clinical trials as that is roughly when most possible treatments become notable, and when people are more likely to be interested in them. I'll start a section when I find a good source. Rod57 (talk) 13:34, 23 June 2010 (UTC)
 * Possibly including Green Tea Extract Appears to Keep Cancer in Check in Majority of CLL Patients which suggests EGCG could be useful one day.
 * More phase II trials - some results : Thalidomide lenalidomide Bafetinib Theophylline flavopiridol forodesine
 * CLL trials in Dec 2009 in Europe Rod57 (talk) 13:52, 23 June 2010 (UTC)
 * Recent phase III trials cladribine vs fludarabine alemtuzumab Rod57 (talk) 14:14, 23 June 2010 (UTC)


 * We'd be better off with a paper that talks about the state of research -- you know, a "Whither Research for CLL?" opinion in a journal, or perhaps a good summary page at a relevant charity website. Relying on reports about individual clinical trials means that we will attract spam, and might mislead the reader (e.g., by presenting a wildly, although unintentionally, unbalanced summary).  WhatamIdoing (talk) 20:06, 23 June 2010 (UTC)
 * Charity website pages will (hopefully) change so are not a good source. It shouldn't be too hard to mention a trial cautiously without misleading. Anyway; I see we now have a rather jumbled section 'Research directions' - I plan to rebalance and update it a bit and use : Novel BTK, PI3K Inhibitors on Horizon for Relapsed CLL. March 2016 ? - Rod57 (talk) 20:45, 22 March 2016 (UTC)

Science News resource, News in Brief: Body & Brain
Gene therapy for leukemia Web edition: Thursday, August 18th, 2011 "Tweaking immune cells to attack cancer cells in leukemia patients can bring about remission, a small study shows. Scientists at the University of Pennsylvania genetically altered immune T cells to target malignant cells in chronic lymphocytic leukemia patients and mass produced the T cells before injecting them into three patients. The modified cells gravitated to bone marrow, where they killed malignant cells. In two of three patients tested the cancer went into remission, and a portion of the genetically modified T cells persisted, possibly as a cadre of defenders on standby. The researchers report the findings in the Aug. 10 Science Translational Medicine." by Nathan Seppa

99.181.140.213 (talk) 04:33, 26 November 2011 (UTC)

Gene Mutations
The IGHV mutation status section is imho mistitled with "Gene Mutations". I would expect genetic aberrations to follow under that heading. However, the mutational status of the IGHV genes is a normal process to develop the B-cell immunglobulin genes and also occurs in non-malignant B-cells. In CLL, IGHV mutational status is only used to stratify patients into prognostic subgroups. Therefore, a better title would be "Patient Stratification according to Genetic Markers" or something similar. Gene mutations would e.g. be mutations of the TP53 gene or the ATM gene that both in CLL lead to resistance against chemotherapy and could be adressed under the "Gene Mutations" heading. — Preceding unsigned comment added by Aimee Anouk (talk • contribs) 15:11, 16 May 2013 (UTC)

Chronic Lymphoid Leukaemia? Really?
Could the medics here confirm that CLL is commonly called "Chronic Lymphoid Leukaemia" as is stated in the lede, and only in the lede? I have only seen this term used here, and never come across it anywhere else. I'd like to remove it altogether, but there are editors here who I would defer to. Thanks -Roxy the dog (resonate) 23:10, 24 March 2014 (UTC)


 * Firstly, I apologise for paging you, but I am slightly conflicted here, and really would like to ask you to spare a moment to give me an opinion before I boldly remove what I want to remove. WhatamIdoing - Doc James  - MastCell


 * Secondly - There is no secondly. Thanks -Roxy the dog (resonate) 23:51, 8 April 2014 (UTC)


 * Yes, it's a valid but less popular name. It appears to parallel "myeloid":  you use "lymphoid" and "myeloid", or you use "lymphocytic" and "myelogenous".  WhatamIdoing (talk) 02:14, 9 April 2014 (UTC)

Reviews
Blood has a series of reviews on CLL here. JFW &#124; T@lk  09:03, 29 July 2015 (UTC)

IGHV mutations/FISH systematic review
10.1182/blood-2015-10-620864 JFW &#124; T@lk  08:05, 8 April 2016 (UTC)

Review
10.1111/bjh.14184 JFW &#124; T@lk  13:07, 20 June 2016 (UTC)

External links modified
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Survival for +/- IgVH
I thought that the survival for CLL that was IgVH positive was about 24 years, while the survival for IgVH negative was 6-8 years. The article cites SEER for a 5-year survival of 83.2%, but they don't distinguish between IgVH +/- or ZAP-70 +/-.

N Engl J Med. 2005 Feb 24;352(8):804-15. Chronic lymphocytic leukemia. Chiorazzi N1, Rai KR, Ferrarini M.

DOI: 10.1056/NEJMra041720 "Patients with clones having few or no V-gene mutations or with many CD38+ or ZAP-70+ B cells had an aggressive, usually fatal course, whereas patients with mutated clones or few CD38+ or ZAP-70+ B cells had an indolent course."

N Engl J Med. 2003 May 1;348(18):1764-75. ZAP-70 expression as a surrogate for immunoglobulin-variable-region mutations in chronic lymphocytic leukemia. Crespo M1, Bosch F, Villamor N, Bellosillo B, Colomer D, Rozman M, Marcé S, López-Guillermo A, Campo E, Montserrat E.

Look at Figure 4 here.

There was a later article in the NEJM which stated this more explicitly, but I can't find it right now. --Nbauman (talk) 00:18, 3 April 2018 (UTC)

Lancet
10.1016/S0140-6736(18)30422-7 JFW &#124; T@lk  08:38, 15 April 2018 (UTC)


 * UK guideline 10.1111/bjh.15460 JFW &#124; T@lk  12:34, 17 July 2018 (UTC)

Sweats / Night sweats
... are not mentioned at all in this article. Why not? -Roxy, the dog . wooF 17:25, 4 October 2019 (UTC)


 * Well, they were, but User:Doc James removed that on the grounds that it isn't mentioned in the (not exactly stellar) source that happens to already be cited at the end of that particular sentence (i.e., not because it's wrong, but because Wikipedia editors these days seem to prefer removing accurate content to adding a second ref). Of course, hematological malignancies top the list at Night sweats; it's real.  It just wasn't already cited in that particular sentence.
 * I think that this particular symptom might be more typical of advanced cases, rather than a typical or early symptom. WhatamIdoing (talk) 01:12, 5 October 2019 (UTC)
 * Per this ref night sweats is not that common.
 * Will add that. Doc James  (talk · contribs · email) 01:28, 5 October 2019 (UTC)

Queen's University Student Editing Initiative
Hello, we are a group of medical student’s from Queen’s University. We are working to improve this article over the next month and will be posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit. Thank you. Orsini.M1 (talk) 20:16, 23 November 2020 (UTC) (Medandchill (talk) 16:48, 1 December 2020 (UTC))
 * Hello people from Queen's.
 * Do me a favour when using Talk pages, add new entries at the bottom not in the middle or at the top.
 * Different subjects need different sections so that we can follow conversations logically.
 * I have edited this page to make things clearer. Thx. -Roxy the inedible dog . wooF 07:35, 2 December 2020 (UTC)

Prognosis
We noticed that the first sentence in the Prognosis section does not match up to the information mentioned in the rest of the article. The sentence we propose to remove is: "Prognosis depends on the subtype". We propose to insert the following sentences into the beginning of the Prognosis section instead: “Prognosis can be affected by the type of genetic mutation that the person with CLL has. Some examples of genetic mutations and their prognoses are: mutations in the IGHV region are associated with a median overall survival (OS) of more than 20-25 years, while no mutations in this region is associated with a median OS of 8-10 years; deletion of chromosome 13q is associated with a median OS of 17 years; and trisomy of chromosome 12, as well as deletion of chromosome 11q, is associated with a median OS of 9-11 years ." Thank you for your time. (Medandchill (talk) 04:00, 2 December 2020 (UTC))

We notice that the survival statistics cited in the Prognosis section has no citation, and incorrectly refers to subtypes of CLL which do not exist. We propose removing this sentence, and replace it with a 5-year relative survival statistic from the National Cancer Institute. I wish to replace the sentence “Some subtypes have a median survival of 6-8 years, while others have a median survival of 22 years (which is normal lifespan for older patients). [Citation Needed]” with the following revision: “While prognosis is highly variable and dependent on various factors including these mutations, the average 5-year relative survival is 86.1% ” LB1212 (talk) 00:02, 5 December 2020 (UTC)
 * Thanks for sharing this. Please not that the citation goes immediately after the punctuation like this (no space after period). Thanks for noting a missing citation as well! JenOttawa (talk) 02:53, 5 December 2020 (UTC)
 * I noticed that your reference # 1 did not fully auto populate with the citation tool. This is not your fault- it some times happens. I looked up the PMID 31278397 and it works better. When you are editing the actual article, please try pasting the PMID into the tool (versus DOI or website) to share the correct citation information. Thanks again for all these great suggestions!JenOttawa (talk) 02:58, 5 December 2020 (UTC)
 * @LB1212 and @Medandchill, if you look at lay-oriented sources such as https://www.cancer.net/cancer-types/leukemia-chronic-lymphocytic-cll/introduction or https://hillman.upmc.com/cancer-care/blood/types/leukemia, they do refer to "subtypes of CLL". Maybe this is not the professional jargon, but the phrase does seem to be used.  It also appears in this patent application – perhaps it's just outdated? WhatamIdoing (talk) 04:27, 5 December 2020 (UTC)

@WhatamIdoing thank you so much for your feedback and providing those references. I looked at them and I believe that we are discussing the same things, just with different words. Because genetic mutations of CLL are mentioned a few times throughout the page, I believe that replacing "subtypes" with "genetic mutations" will provide a more streamlined reading experience. Genetic mutations is also more precise and accurate compared to just mentioning subtypes. Thank you for your time. (Medandchill (talk) 19:14, 7 December 2020 (UTC))


 * That sounds good, Medandchill.
 * I wonder whether there are any other prognostic factors that would be useful to mention up front? In general, for any type of cancer affecting primarily older people, age and health status is a significant factor for long-term survival.  If you're 99 years old at the time of diagnosis, then you still might not reach the five-year survival point, even if the treatment produces perfect results.  But I don't know if the sources you're looking at bother with that kind of obvious information. WhatamIdoing (talk) 21:28, 7 December 2020 (UTC)

Causes section
In order to include more detail and a relevant source, we propose to replace the first sentence of the Causes section, “CLL is caused by multiple genetic mutations and epigenetic changes,” with the following sentences: “CLL can be caused by many different genetic mutations, the most common being deletions in the 13q14.3 region, (seen in 50% of CLL cases), as well as trisomy in chromosome 12 (seen in 20% of cases), other deletions (i.e., in 11q22-23, 17p13, or 16q21 regions), and less commonly, translocations (for example, involving the 13q14 region). 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). " --Step1 jan (talk) 06:22, 2 December 2020 (UTC)

I propose to change the sentence "Some relevant genetic mutations may be inherited; in around 9% of CLL cases a parent had CLL." in the Causes section for the following three sentences: Some relevant genetic mutations may be inherited. 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. Up until 2014, very few of these mutations or significant “risk alleles” had been identified. --Maferhuicom
 * Thanks for sharing both of these improvements. Good placement of your citations and use of wikilinks. JenOttawa (talk) 03:00, 5 December 2020 (UTC)
 * I have a small note regarding using your same reference more than once in one article. When you add your references while editing the actual article, you can see the options "automatic Manual Re-use". The first time you add the citation (if it is not already used in an article, click "automatic" and add your PMID, DOI, or website, then click "generate" to fill the template. The second time you want to use the same citation in an article, click "reusue" and search for your citation in the list. This adds in the a,b,c versus duplicating the citation in the list. If possible, practice this in your sandbox before editing live on Monday. Thanks again!JenOttawa (talk) 03:04, 5 December 2020 (UTC)

Introduction section
We propose to replace these two sentences in the introductory section: “Management of early disease is generally with watchful waiting. Infections should more readily be treated with antibiotics.” We propose to replace them with the following: “Early-stage CLL in asymptomatic cases responds better to careful observation, as there is no evidence that early intervention treatment can alter the course of the disease. Immune defects occur early in the course of CLL and these increase the risk of developing serious infection, which should be treated appropriately with antibiotics. ” Thank you for your time.Shea46 (talk) 17:19, 2 December 2020 (UTC)

We noticed that a sentence in the last paragraph of the introduction could be expanded upon to include more specific detail. The sentence we propose to adjust is: “Males are affected more often than females.” We propose to add to the sentence by including a ratio between men and women. Our proposed sentence is as follows: “Men are diagnosed around twice as often as women (6.8 to 3.5 ratio). ” Thank you for your time.(Bob Dargin (talk) 21:50, 2 December 2020 (UTC))
 * Thanks for sharing this here! Good use of lay language in your first two sentence replacement suggestion. The Lead (Wikipedia's name for an introduction) has it's own style and lay language is strongly suggested here for Wikipedia's non-medical background readers. Please note the placement of your citations, after the punctuation, not before! I know this is a little picky, we are definitely not marking these types of things, but when you edit on Monday please keep this in mind in order that the final Wikipedia article is formatted correctly.JenOttawa (talk) 03:09, 5 December 2020 (UTC)
 * Please note the information that I gave the suggestion above yours regarding the multiple use of the same reference. We try really hard not to have duplicate refererences in the reference list. Thanks again!JenOttawa (talk) 03:10, 5 December 2020 (UTC)

Signs and Symptoms Section
To provide context for the term SLL and explain its relation to CLL, we propose to add two sentences to the beginning of the Signs and Symptoms Section: "CLL can be grouped with Small lymphocytic lymphoma (SLL) as one disease with two clinical presentations. Wherein, with CLL, diseased cells propagate from within the bone marrow, in SLL they propagate from within the lymphatic tissue. " Thank you for your time. Orsini.M1 (talk) 03:41, 5 December 2020 (UTC)

To provide fluidity between the newly proposed changes above and the existing sentences, we propose to edit the first portion of the first sentence in the signs and symptoms section from: "CLL is, in virtually all cases, preceded..." to "CLL and SLL are, in virtually all cases, preceded..." Thank you for your time. Orsini.M1 (talk) 03:49, 5 December 2020 (UTC)