Hello, I am Greg Nowakowski and I’m a hematologist at Mayo Clinic with particular interest in treatment of patients with lymphoma and chronic lymphocytic leukemias I would like to talk today about leukemia, what is called LGL leukemia or large granular lymphocyte leukemia, which is one of the rarest chronic lymphocytic leukemias we see. This is a very interesting and unusual disease because it tends to present, contrary to other leukemias, in most of the patients with low white cell counts rather than high white cell count, and that’s why it presents particular diagnostic challenge and diagnostic difficulty for a lot of hematologists. LGL leukemia comes really in two subtypes. There is an NK-cell subtype, which is exceedingly rare, and a T-cell subtype, which is more common. What’s characteristic of those diseases, that both tend to be chronic, although NK-cell disease occasionally can be more aggressive, and management of patients with these disorders have to really focus on long-term outcomes with the goal of providing the treatment which does not affect future therapy choices and treats leukemia with minimal toxicity, focusing on improvement of blood counts and suppressing of the leukemia. Now, probably the most important message about LGL leukemia is that the treatment actually, although frequently involves chemotherapy, it involves a relatively mild form of chemotherapy. So often when people hear the word leukemia it is scary and people worry about having chemotherapy causing hair loss and prolonged hospitalizations and a lot of infectious complications and that’s actually not the case for the patients with LGL leukemia. In fact, the opposite can be said. A lot of our patients will be treated with oral therapy, with oral mild chemotherapy regimens and it — with this relatively modest therapy, they will achieve excellent clinical result. It’s a group of physicians, a chronic lymphocytic leukemia group which we focus specifically on LGL, and we are actually one of the world’s largest centers for LGL disorders. In fact, we have seen more patients with LGL disorders than any other center in the world, over 300 in last 20 years. Now, we at Mayo have benefited here greatly with collaboration of our pathologists who have also interest in this leukemia and develop expertise in early recognition of this leukemia on the bone marrow biopsies and also from peripheral blood. Most of the patients which we see here will be referred from all over the country or sometimes from abroad for initial diagnosis and recommend — management for recommendations of this leukemia. We have a collaboration here with Dr. Bill Morice who is a world-renowned pathologist, and his input in recognizing leukemia [unclear word] within the bone marrow and accurate diagnosis has been invaluable in our practice Because we are seeing so many patients with LGL leukemia here at Mayo, we have developed a fairly active research program in LGL leukemia as well, and this research program is really focusing on two aspects. One is on the prognostic factors in LGL leukemia, number one, to identify the patients in need of immediate therapy; number two, to tailor therapy to individual patient based on the biomarkers of the initial diagnosis. And the other area of research, where active research is trying to identify new targeted agents which could work in this type of leukemia so in the future we can avoid using chemotherapy and we can switch towards more novel, new targeted agents which specifically target leukemic cells rather than targeting other cells in the body.
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