Chronic lymphocytic leukemia

Last reviewed: 29 Dec 2022
Last updated: 10 Jan 2023

Summary

Definition

History and exam

Key diagnostic factors

  • shortness of breath and fatigue
  • lymphadenopathy
  • splenomegaly
  • hepatomegaly
More key diagnostic factors

Other diagnostic factors

  • B symptoms
  • recurrent infections
  • petechiae
Other diagnostic factors

Risk factors

  • age over 60 years
  • male sex
  • white ethnicity
  • family history of CLL
More risk factors

Diagnostic investigations

1st investigations to order

  • WBC count with differential
  • blood film
  • hemoglobin
  • platelet count
  • flow cytometry
More 1st investigations to order

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
More investigations to consider

Treatment algorithm

ACUTE

asymptomatic early-stage (Binet A and B; Rai 0-II)

advanced (Binet C; Rai III-IV) or symptomatic disease

ONGOING

relapsed or refractory disease

Contributors

Authors

Jacqueline C. Barrientos, MD, MS

Associate Professor

Department of Medicine

Zucker School of Medicine at Hofstra/Northwell

CLL Research & Treatment Program

Northwell Health Cancer Institute

Lake Success

NY

Disclosures

JCB has been a consultant for Beigene, Abbvie, and AstraZeneca; received honoraria from Janssen; and received research funding from Oncternal, VelosBio, and Pharmacyclics.

Joanna M. Rhodes, MD, MSCE

Assistant Professor

Department of Medicine

Zucker School of Medicine at Hofstra/Northwell

CLL Research and Treatment Program

Northwell Health Cancer Institute

Lake Success

NY

Disclosures

JMR has been a consultant for Abbvie, Genentech, Pharmacyclics, AstraZeneca, Beigene, Verastem, TG Therapeutics, Jannsen, and SeaGen.

Acknowledgements

Dr Jacqueline C. Barrientos and Dr Joanna M. Rhodes would like to gratefully acknowledge Dr Vidhya Murthy, Dr Shankaranarayana Paneesha, and Dr Robert Chen, previous contributors to this topic.

Disclosures

VM has received a consultancy fee from Janssen, and a grant from Takeda for the ASH Annual Meeting 2014. SP has received consultancy and speaker fees from Janssen, Gilead, AbbVie, Bristol-Myers Squibb, and Takeda. 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.

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