J.T. is a 45-year old male who experiences fatigue and shortness of breath during normal activities. In addition, he complains of soreness in his groin. He also reports that minor cuts wil not heal, J.T. easily bruises, and that he is prone to recurrent fevers and infections. Physical Exam J.T. is pale and has small, red spots on his skin (petechiae). adenopathy: presence of enlarged smal soft nodes in supraclavicular and axilary areas (-1 cm dameter) and two larger firm inguinal nodes (>2 am diameter). No other organomegaly. The rest of the exam was within normal limits. Based on JT.'s history and physical exam, his physician orders a CBC. Results are below. Complete Blood Count (CBC) note: mci = mieroliter Cell Type Red Blood Cells (RBC) Hemoglobin (HGB) Hematocrit (HCT) White Blood oels (WIC) Neutrophis (NE) Lymphooytes (LY) Eosinophils (E) Basophils (B) Monocytes (MO Platelets (PLT) J.T.s Values 4.02 x 10 cels/L 136 gidL 38.3% 51.3 x 10 cellsL 10% Normal Values 4.5-5.5 x 10" cellsL 14.17.4 ad 42-52% 4.5-11x10 cels/L 49-74% 89% 1% 26-46% 1-3% 1% 0-9% 150-450 x 10L 156 x 10L 1. Why are his lymph nodes enlarged (adenopathy)? How does this fit with his CBC test? Immunophenotyping More than 90% of the tymphoid cells in J. Ts bone marrow are monotypicimonocional B lymphocytes with >5 x 10L peripheral Blymphocytes with strong expression of the proteins CDS, CD19, and CD23 and weak expression of the proteins CD20, CD796, and surface immunoglobuin (sig). After seeing J.T.'s CBC values, J.Ts physician orders a bone marrow biopsy. The bi shows that J.T.'s bone marrow possesses abnormal numbers and morphology of specific cells biopsy Bone marrow biopsy results: 68% lymphocytes were morphologically simlar to those found in the blood >90% of the lymphoid cells in the marrow are monotypicimonocional B-lymphocytes Cytogenatics: 46 chromosomes; XY sex chromosomes. No numerical or structural chromosome abnormalities detected. 2 What is the most likaly diagnosis that explains all of J.T.'s symptoms and lab results? Be specitic as to kind and type of disease (specitic name of disease). 3. What is the typical course of treatment for a person with J.T.'s condition? Six months after his initial diagnosis, J.T.'s illness has dramatically worsened and his condition is no longer responding to initial treatments. A CBC shows his platelet count has dropped dramatically and red blood cell count is low. His physician suggests that J.T. consider undergoing stem cell therapy. 4. Describe the type of stem cell therapy used to treat people with J.T.'s condition. What are the risks and benefits of this therapy?