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Chronic lymphocytic leukemia

  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 18 Aug 2025
最后更新： 21 Mar 2025

小结

定义

病史和体格检查

关键诊断因素

  • shortness of breath and fatigue
  • lymphadenopathy
  • splenomegaly
  • hepatomegaly
完整详情

其他诊断因素

  • B symptoms
  • recurrent infections
  • epistaxis
  • pallor
  • petechiae
完整详情

危险因素

  • age over 60 years
  • male sex
  • white ethnicity
  • family history of CLL
完整详情

诊断性检查

首要检查

  • CBC count with differential
  • flow cytometry
  • peripheral blood smear
完整详情

需考虑的检查

  • serum beta-2 microglobulin
  • fluorescent in situ hybridization (FISH)
  • molecular genetic tests
  • direct antiglobulin test (DAT)
  • serum quantitative immunoglobulin
  • lymph node biopsy
  • bone marrow aspirate and trephine biopsy
  • CT scan/fluorodeoxyglucose (FDG)-PET/CT
完整详情

治疗流程

急症处理

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

advanced stage (Binet C; Rai III-IV) or with indications for treatment (e.g., symptoms)

持续性治疗

relapsed or refractory disease

撰稿人

作者

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

利益声明

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

利益声明

JMR has received fees for consulting for Abbvie, Genentech, Pharmacyclics, Beigene, AstraZeneca, Morphosys, Epizyme, ADC Therapeutic, TG Therapeutics, Versatem, SeaGen, and Jannsen. JMR’s institution has received research support from Oncternal Pharmaceutics, Pharmacyclics, Acerta, Loxo Oncology, Velosbios, Abbvie, and AstraZeneca.

鸣谢

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.

利益声明

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.

同行评议者

Alessandra Ferrajoli, MD

Associate Medical Director, Professor

Department of Leukemia Center

The University of Texas MD Anderson Cancer Center

Houston

TX

利益声明

AF declares that she has no competing interests.

Farrukh Awan, MD

Professor of Medicine

Department of Internal Medicine

UT Southwestern Medical Center

Dallas

TX

利益声明

FA 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

利益声明

PFC has received honoraria from Celgene for participation in a speaker bureau, and from Kite Pharma for participation in an advisory board.

Daniel Catovsky, MD, FRCP, FRCPath, DSc, FMedSc

Consultant Haemato-oncologist

Section of Haemato-Oncology

The Institute of Cancer Research

Sutton

UK

利益声明

Unfortunately, we have since been made aware that DC is deceased

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018 Jun 21;131(25):2745-60.全文  摘要

Walewska R, Parry-Jones N, Eyre TA, et al. Guideline for the treatment of chronic lymphocytic leukaemia. Br J Haematol. 2022 Jun;197(5):544-57.全文  摘要

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma [internet publication].全文

Eichhorst B, Robak T, Montserrat E, et al; ESMO Guidelines Committee. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021 Jan;32(1):23-33.全文  摘要

Hallek M, Al-Sawaf O. Chronic lymphocytic leukemia: 2022 update on diagnostic and therapeutic procedures. Am J Hematol. 2021 Dec 1;96(12):1679-705.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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