Chronic Lymphocytic Leukemia

The most prevalent leukemia is chronic lymphocytic leukemia. It is a clonal B lymphocyte malignancy. The average age of presentation is 65–70, and it affects men 2:1 more frequently than women.

Clinical features

• Incidental results are frequently found when a hemogram is performed for another reason.
• Splenomegaly
• Fatigue
• Frequent infections
• New asymptomatic lymphadenopathy
• Night sweats
• Weight loss
• Immunological anomalies include hypogammaglobulinemia, autoimmune thrombocytopenia, and autoimmunity hemolytic anemia.

Diagnosis

• Blood
• Monoclonal B cells that express the CD5 antigen and have a lymphocyte count of at least 4×109/L
• Nuclear remnants of cells injured during smear preparation (known as “smudge” or “basket” cells).
• Monoclonal B lymphocytes infiltrating the bone marrow
• Lymph node biopsy (if lymphadenopathy):
• small lymphocytic lymphoma

Staging

• Clinical stage A (60 %) – No thrombocytopenia or anemia, and no more than three sites of lymphoid expansion
• Clinical stage B (30 % patients) – Three or more affected regions of lymphoid enlargement without anemia or thrombocytopenia
• Clinical stage C (10 % patients) – Anaemia or thrombocytopenia, irrespective of the number of lymphoid enlargement sites

Differential diagnosis

• Hairy cell leukemia
• Follicular lymphoma
• Mantle cell lymphoma
• Splenic marginal zone lymphoma
• Nodal marginal zone lymphoma
• lymphoplasmacytic lymphoma

Treatment

Stage A – Follow-up without specific therapy

Stage B – Most will require treatment in the first few years

Stage C – Require therapy

Single therapy:

• Chlorambucil – for elderly pts
• Fludarabine – for young pts

Combination therapy:

• Chlorambucil + Fludarabine
• Rituximab + Fludarabine + Cyclophosphamide