Furthermore, it is most active in the blood, bone marrow and spleen, all of which are main sites involved with B-PLL and thus could serve as a potential agent in treating this disease with more research

Splenectomy or Radiation Therapy to Spleen
Patients with splenomegaly (enlarged spleen), unfit for systemic treatment or refractive to chemotherapy may have their spleens removed via splenectomy or undergo splenic irradiation in order to relieve pain, control their symptoms, and allow removal of a major proliferative focus and tumour bulk in this disease.Splenic irradiation has been used in the treatment. Stem Cell Transplantation
A stem cell transplant is a procedure that uses highly specialized cells called hematopoietic stem cells to replace bone marrow that contains the leukemia. This procedure should be considered in younger patients that have responded well to initial treatments because the progression and spread of this disease is inevitable. However, stem cell transplantation is a high-risk procedure, with significant morbidity and mortality rates. Furthermore, it is often not a feasible option due to the presence of other systemic diseases/conditions. Prognosis
Despite advancements in treatments and deeper understanding of pathogenesis, the prognosis for B-PLL patients is poor
, with early relapse and median survival time between 3–5 years. Epidemiology
B-PLL represents less than 1% of all leukemia cases worldwide, mainly affecting the elderly population with a mean age of presentation between 65 and 70 years. Most cases have shown slight male predominance, with a male-to-female ratio of 1.6 to 1, and the vast majority of patients being Caucasians. References


== External links ==
DuPont purchased Mercks share in the joint venture in 1998 and began operating the company as DuPont Pharmaceuticals (DuPont Pharma), but Merck continued to manufacture the drug for DuPont. Starting in late 2009 and continuing into 2011 Merck stopped manufacturing the drug while awaiting regulatory approvals due to a change in the supplier of the active ingredient. This resulted in shortages of the brand name products Sinemet and Sinemet CR, although alternative generic versions were still available.Another shortage appears to have occurred at the end of 2017. See also
Stalevo in combination with entacapone

References
External links
"Carbidopa mixture with levodopa". Drug Information Portal. U.S. National Library of Medicine.