Diagnostic, pronostic et traitement chez les patients avec une leucémie lymphoïde chronique

B-Chronic lymphocytic leukaemia (CLL) is the most frequent of chronic leukaemias. It is defined by a durable absolute lymphocytosis (> 4 × 109/l) with small mature lymphoid cells in the peripheral blood. Immunological score established on five criterias (positivity of CD5 and CD23, negativity of the FMC7 and weak expression of sIg and CD22 or CD79b) is four or five. The Binet classification defines three stages of different evolution: the stage A (65% of the cases) and B (28%) without or with three areas involved at least, in the absence of anaemia or thrombopenia and the stage C with anaemia (haemoglobin lower than 10 g/dl) or thrombopenia (platelets lower than 100 × 109/l). Patients with stage A will a few progress quickly and conversely others will remain stable with no evolution for very long periods. Four markers with prognosis value were recently identified and allow to adopt new therapeutic strategies according to the presence or not of these markers. These factors are lymphocytes doubling time, serum thymidine kinase, cytogenetic abnormalities including del(11) and del(17), +12 and del(13), and the immunoglobulin mutational profile. The therapeutic strategies evolved these last years and call, if criteria of gravity are present, to chemotherapy (purines analogs associated or not with cyclophosphamid) and immunotherapy (anti-CD20 and/or anti-CD52 monoclonal antibody).