Chronic lymphocytic leukaemia - Chronic leukaemia

Chronic leukaemia

Chronic lymphocytic leukaemia

Definition

Chronic lymphocytic leukaemia (CLL) is a leukaemic proliferation of mature B lymphocytes.

Incidence

1.8–3 per 100,000 per year

Age

Peak diagnosis 60–70 years

Sex

M > F

Pathophysiology

Although there is a proliferation in B cells they have abnormal function resulting in hypogammaglobulinaemia. Staging is shown in Table 12.7.

Clinical features

Patients may be asymptomatic. Symptoms result from marrow failure (anaemia, infection and bleeding). On examination there may be lymphadenopathy and hepatosplenomegaly.

Investigations

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.

Management

CLL frequently requires no treatment other than supportive measures. Symptomatic disease may be treated with intermittent chemotherapy such as chlorambucil or fludarabine.

Prognosis

Prognosis is related to clinical staging.