Chronic lymphocytic leukaemia

Chronic lymphocytic leukaemia (CLL) is an indolent haematological cancer that occurs with increasing age.

Usually presents with absolute lymphocytosis as an incidental finding on routine full blood count (FBC) or with asymptomatic lymphadenopathy.

Diagnosed by FBC with differential, blood smear showing smudge cells, and flow cytometry.

Variable clinical course with most patients experiencing very slow progressive disease.

Clinical and laboratory criteria are used to determine treatment approach and prognosis.

Treatment options include a conservative approach (active surveillance), chemoimmunotherapy, and targeted therapies. Stem cell transplant is an option for high-risk disease.

Median survival has improved with the availability of targeted therapies.

CLL is an indolent lymphoproliferative disorder in which monoclonal B lymphocytes (>5 x 10⁹/L [>5000 cells/microlitre]) are predominantly found in peripheral blood.[1]Alaggio R, Amador C, Anagnostopoulos I, et al. The 5th edition of the World Health Organization classification of haematolymphoid tumours: lymphoid neoplasms. Leukemia. 2022 Jul;36(7):1720-48. https://www.nature.com/articles/s41375-022-01620-2 http://www.ncbi.nlm.nih.gov/pubmed/35732829?tool=bestpractice.com Lymphocytosis is sustained for at least 3 months.[2]Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018 Jun 21;131(25):2745-60. https://ashpublications.org/blood/article/131/25/2745/37141/iwCLL-guidelines-for-diagnosis-indications-for http://www.ncbi.nlm.nih.gov/pubmed/29540348?tool=bestpractice.com If these cancer cells are found predominantly in lymph nodes, the disorder is called small lymphocytic lymphoma.