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 complete blood count (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 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 (>5000 cells/microliter [>5 x 10⁹/L]) are predominantly found in peripheral blood. Lymphocytosis is sustained for at least 3 months. 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 sex
- 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
relapsed or refractory disease
- Leukemic phase of lymphoma
- Hematopoietic cell transplantation (HCT)
- Guideline for the treatment of chronic lymphocytic leukaemia
Leukemia (chronic lymphocytic)More Patient leaflets
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