Chronic Lymphocytic Leaukaemia

Question 1

Typical presentation?

Answer 1

” 62 y/o man presents for routine FBC for tiredness. He is healthy. O/e he has generalised lymphadenopathy but they are non-painful so he has hardly noticed them. A differentiated FBC is taken showing 80% of the WCC are lymphocytes. “

Question 2

Symptoms?

Answer 2

Very vague and general
Think old person with new tiredness/high cell turnover symptoms

• Fatigue
• Dyspnoea
• Splenomegaly

Question 3

What staging is used in CLL?

Answer 3

Binet’s staging

Question 4

What is Binet’s stage 1?

Answer 4

High WCC
Slightly anaemic
<3 lymphoid organs affected (includng nodes)

Question 5

Binet’s stage 2?

Answer 5

High WCC
Slightly anaemic
>3 lymphoid organs affected (including nodes)

Question 6

Binet’s stage 3?

Answer 6

High WCC
Anaemia/thrombocytopenia
Multiple lymphoid involvement
B symptoms

Question 7

Investigation?

Answer 7

FBC
- Differential WCC (shows lymphocytes as majority cells)

Bone marrow
- >30% lymphocytes

Question 8

How is treatment divided?

Answer 8

Binet’s staging

Question 9

Treatment for Binet’s stage 1/2?

Answer 9

Observation

Question 10

Treatment for Binet’s C?

Answer 10

Chemotherapy

Question 11

Chemo regimen?

Answer 11

FCR

• Fludrabine
• Cyclophosphamide
• Rituximab