Chronic lymphocytic leukemia (CLL) is an indolent hematologic cancer that occurs with increasing age.
Usually presents with absolute lymphocytosis as an incidental finding on routine CBC or with asymptomatic lymphadenopathy.
Diagnosed by CBC 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 (watch and wait) approach, chemoimmunotherapy, targeted therapies, and stem cell transplant.
Median survival has improved with the availability of targeted therapies.
Chronic lymphocytic leukemia (CLL) is an indolent lymphoproliferative disorder in which monoclonal B lymphocytes (>5 x 10⁹/L) are predominantly found in peripheral blood. If these cancer cells are found predominantly in lymph nodes, the disorder is called small lymphocytic lymphoma.
History and exam
Key diagnostic factors
- shortness of breath and fatigue
Other diagnostic factors
- B symptoms
- recurrent infections
- age over 60 years
- male gender
- white ethnicity
- family history of CLL
1st investigations to order
- WBC count with differential
- blood film
- platelet count
- flow cytometry
Investigations to consider
- fluorescent in situ hybridization (FISH)
- molecular genetic analysis
- direct antiglobulin test (DAT)
- immunoglobulin levels
- bone marrow aspirate and trephine biopsy
- CT scan
asymptomatic early stage (Binet A and B; Rai 0-II)
advanced (Binet C; Rai III-IV) or symptomatic disease
early relapse or refractory disease
- Leukemic phase of lymphoma
- Chronic lymphocytic leukemia/small lymphocytic lymphoma
- Chronic lymphocytic leukaemia
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