Chronic lymphocytic leukaemia
Chronic lymphocytic leukaemia (CLL) is a leukaemic proliferation of mature B lymphocytes.
1.8–3 per 100,000 per year
Peak diagnosis 60–70 years
M > F
Although there is a proliferation in B cells they have abnormal function resulting in hypogammaglobulinaemia. Staging is shown in Table 12.7.
Patients may be asymptomatic. Symptoms result from marrow failure (anaemia, infection and bleeding). On examination there may be lymphadenopathy and hepatosplenomegaly.
Full blood count reveals a low or normal haemoglobin, a white cell count >15 × 109/litre of which at least 40% are lymphocytes, platelets are low or normal. Autoimmune haemolytic anaemia/ thrombocytopenia are present in 10%.
Blood film demonstrates a high lymphocyte count and because these are fragile they appear as smear or basket cells.
Hypogammaglobulinaemia may be present.
CLL frequently requires no treatment other than supportive measures. Symptomatic disease may be treated with intermittent chemotherapy such as chlorambucil or fludarabine.
Prognosis is related to clinical staging.