Chronic Leukemias 🧬 CLL vs CML, Smudge Cells, BCR-ABL, Modern Targeted Therapy | USMLE Step 2 CK

Описание: 📌𝗝𝗼𝗶𝗻 𝗢𝘂𝗿 𝗧𝗲𝗹𝗲𝗴𝗿𝗮𝗺 𝗖𝗵𝗮𝗻𝗻𝗲𝗹 𝗛𝗲𝗿𝗲:-https://t.me/conceptualmedicine009
📌 𝐅𝐨𝐥𝐥𝐨𝐰 𝐨𝐧 𝐈𝐧𝐬𝐭𝐚𝐠𝐫𝐚𝐦:- https://www.instagram.com/conceptual_...

Chronic Leukemias Made Simple 🧬 CLL vs CML, Smudge Cells, BCR-ABL, Modern Targeted Therapy | USMLE Step 2 CK High-Yield

Master chronic leukemias for USMLE Step 2 CK with a crisp clinic-first roadmap that separates CLL from CML in seconds and links each to modern therapy. Chronic lymphocytic leukemia presents with asymptomatic lymphocytosis, painless lymphadenopathy, hepatosplenomegaly, fatigue, and recurrent infections; smear shows fragile smudge cells, flow cytometry confirms clonal B cells CD5 positive, CD23 positive; stage with Rai or Binet and assess prognostics del17p or TP53 mutation, unmutated IGHV, complex karyotype. Treat only if symptomatic B symptoms, bulky nodes, progressive cytopenias, or autoimmune hemolysis refractory to steroids; first-line options favor targeted agents ibrutinib or acalabrutinib BTK inhibitors or venetoclax plus obinutuzumab time-limited for TP53 intact and high-risk disease; give vaccines, avoid live vaccines on therapy, and monitor for tumor lysis with venetoclax. Chronic myeloid leukemia is a myeloproliferative neoplasm driven by BCR-ABL1 t 9;22 Philadelphia chromosome with leukocytosis, basophilia, splenomegaly, and low LAP score; confirm with BCR-ABL PCR or FISH. Frontline therapy uses tyrosine kinase inhibitors imatinib, dasatinib, nilotinib with molecular response monitoring by quantitative PCR; manage cytopenias and drug-specific toxicities prolonged QT with nilotinib, pleural effusions with dasatinib; accelerated phase and blast crisis require TKI escalation, AML-type chemo, and transplant evaluation. Differentiate CML from leukemoid reaction by basophilia, very high WBC with full myeloid spectrum, and BCR-ABL positivity; peripheral smear in CLL shows mature-appearing lymphocytes with smudging, hypogammaglobulinemia drives infections, and autoimmune cytopenias respond to steroids or rituximab. Bedside moves include hydroxyurea for rapid cytoreduction in symptomatic CML, allopurinol or rasburicase for TLS risk, and zoster prophylaxis for anti-CD20 or BTK inhibitor regimens. Exam pearls to lock: painless lymphadenopathy plus smudge cells equals CLL; massive leukocytosis with basophilia and BCR-ABL equals CML; treat CLL only when symptomatic, but start TKIs immediately for newly diagnosed CML; leukemoid reaction has high LAP score and no BCR-ABL. 🩺📈✨


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