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Chapter: Medicine and surgery: Haematology and clinical Immunology

Chronic lymphocytic leukaemia - Chronic leukaemia

Chronic lymphocytic leukaemia (CLL) is a leukaemic proliferation of mature B lymphocytes. - Definition, Incidence, Aetiology, Pathophysiology, Clinical features, Complications, Investigations, Management, Prognosis.

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

 

> 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.

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