Chronic lymphocytic leukemia
Summary
Definition
History and exam
Key diagnostic factors
- shortness of breath and fatigue
- lymphadenopathy
- splenomegaly
- hepatomegaly
Other diagnostic factors
- B symptoms
- recurrent infections
- petechiae
Risk factors
- age over 60 years
- male gender
- white ethnicity
- family history of CLL
Diagnostic investigations
1st investigations to order
- WBC count with differential
- blood film
- hemoglobin
- 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
Treatment algorithm
asymptomatic early stage (Binet A and B; Rai 0-II)
advanced (Binet C; Rai III-IV) or symptomatic disease
late relapse
early relapse or refractory disease
Contributors
Authors
Vidhya Murthy, MBBS, MRCP, FRCPath
Consultant Haematologist
Department of Haematology & Stem Cell Transplantation
Birmingham Heartlands Hospital
Birmingham
UK
Disclosures
VM declares that she received a consultancy fee from Janssen, and a grant from Takeda for the ASH Annual Meeting 2014.
Shankaranarayana Paneesha, MD, FRCP, FRCPath
Consultant Haematologist
Department of Haematology & Stem Cell Transplantation
Birmingham Heartlands Hospital
Birmingham
UK
Disclosures
SP declares that he has received consultancy and speaker fees from Janssen, Gilead, AbbVie, Bristol-Myers Squibb, and Takeda.
Acknowledgements
Dr Vidhya Murthy and Dr Shankaranarayana Paneesha would like to gratefully acknowledge Dr Robert Chen, a previous contributor to this monograph.
Disclosures
RC declares that he has no competing interests.
Peer reviewers
Daniel Catovsky, MD, FRCP, FRCPath, DSc, FMedSc
Consultant Haemato-oncologist
Section of Haemato-Oncology
The Institute of Cancer Research
Sutton
UK
Disclosures
DC declares that he has no competing interests.
Paolo F. Caimi, MD
Associate Professor
Department of Medicine
Case Western Reserve University
Case Comprehensive Cancer Center
Cleveland
OH
Disclosures
PFC has received honoraria from Celgene for participation in a speaker bureau, and from Kite Pharma for participation in an advisory board.
Differentials
- Leukemic phase of lymphoma
More DifferentialsGuidelines
- Chronic lymphocytic leukemia/small lymphocytic lymphoma
- Chronic lymphocytic leukaemia
More GuidelinesPatient leaflets
Leukemia (chronic lymphocytic)
More Patient leaflets
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer