History and exam

Key diagnostic factors

common

shortness of breath and fatigue

Due to anemia caused by CLL, or due to autoimmune hemolytic anemia (a complication of CLL occurring in 5% to 10% of patients).[34][35]

Shortness of breath may be present in patients with advanced disease.

lymphadenopathy

Painless lymphadenopathy is common.[3]

Presence of lymphadenopathy can guide staging and treatment. See Diagnostic criteria and Management sections.

splenomegaly

Present in approximately 50% of cases.[4]

Presence of splenomegaly can guide staging and treatment. See Diagnostic criteria and Management sections.

uncommon

hepatomegaly

Present in approximately 14% of cases.[4] 

Presence of hepatomegaly can guide staging and treatment. See Diagnostic criteria and Management sections.

Other diagnostic factors

uncommon

B symptoms

A minority of patients (approximately 10%) present with B symptoms (fever, drenching night sweats, unintentional weight loss) or other symptoms (e.g., chills, fatigue).[4]

Presence of B symptoms can guide treatment. See Management section.

recurrent infections

Due to dysfunctional lymphocytes and subsequent hypogammaglobulinemia.

May be present in patients with advanced disease.

epistaxis

Sign of thrombocytopenia.

May be present in patients with advanced disease.

pallor

Sign of anemia.

petechiae

Sign of thrombocytopenia.

Risk factors

strong

age over 60 years

Median age at diagnosis in the US is 71 years; approximately 70% of diagnoses occur in people age ≥65 years.[7]

family history of CLL

Approximately 5% to 10% of cases are familial.[15][16]

One Swedish registry study reported a 7.5-fold increased risk for CLL in first-degree relatives of those with CLL.[31]

weak

male sex

CLL is more common in men than in women (6.5 vs. 3.5 new cases per 100,000, respectively; 2019-2023, age-adjusted US data).[7]

white ethnicity

In the US, incidence of chronic lymphocytic leukemia (CLL) is greatest in non-Hispanic white people (8.2 new cases per 100,000 males and 4.4 new cases per 100,000 females, respectively; 2019-2023, age-adjusted US data).​[7]

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