Chronic Lymphocytic Leukemia
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Introduction
Incidence of up to 20/100,000 per year
median age of onset is 65-70 years
Males are more commonly affected.
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Pathophysiology
CLL is an accumulation of monoclonal B lymphocytes due to decreased apoptosis. These cells collect in the bone marriw, blood, lymph nodes, and spleen.
Signs and Symptoms
- history
- physical exam
History
Symptoms can be subtle and with a slow onset; many patients are diagnosed incidentally, with routine bloodwork.
Common presenting symptoms include:
- fevers, night sweats, and weight loss (B symptoms)
- recurrent infection
- painless, enlarged lymph nodes
- abdominal discomfort or early fullness, secondary to splenomegaly
- fatigue, poor exercise tolerance, or dizziness secondary to anemia
- bleeding, secondary to thrombocytopenia
Physical Exam
Accumulation of lymphocytes leads to:
- hepatomegaly
- splenomegaly
- lymphadenopathy
- pallor
- opportunistic infections
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Complete blood count
- elevated WBC count, with lymphocytes above 5 x10^9
- anemia (AIHA)
- thrombocytopenia (ITP)
lactate dehydrogenase (LDH) may also be elevated
peripheral smear
- smudge cells
flow cytometry demonstrates B lymphocytes with CD5+ (T cell marker) present
Dysfunctional lymphocytes lead to immunoglobulin deficiencies
Diagnostic Imaging
Differential Diagnosis
Treatments
Early treatment does not prolong survival.
Chemotherapy may be used in asymptomatic people, including chlorambucil.
Prednisone may also be used.
Consequences and Course
CLL is an indolent disease. Many people die with it, not of it. Survival is 10 years with early stage disease.
Richter's transformation to Non-Hodgkin's lymphoma is possible with CLL.
Resources and References
Topic Development
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