Chronic Lymphocytic Leukaemia

Question 1

What is chronic lymphocytic leukaemia

Answer 1

A clonal lymph-proliferative disorder of mature B lymphoid compartment (less primitive) with intact maturation/differentiation

Question 2

Why is the name of CLL misleading?

Answer 2

It frequently involves the lymph nodes, liver & spleen

Question 3

CLL clinical presentation

Answer 3

• Asymtpomatic
• Non specific (night sweats, fever, fatigue, weight loss)
• Lymph node/ spleen enlargement associated symptoms
• Marrow infiltration (cytopenia)
• Immunocompromised (infections)
• Autoimmune cytopenia (Haemolysis & ITP)

Question 4

What is the association between CLL & autoimmune conditions

Answer 4

CLL can cause the immune system to target its own blood cells (autoimmune cytopenia)
CLL patients can present with AUTOIMMUNE HAEMOLYSIS & IMMUNE THROMBOCYTOPENIA

Question 5

CLL diagnostic work up

Answer 5

1. FBC & Blood film (morphology)
2. Bone marrow (morphology)
3. Bone marrow (immunophenotyping)
4. Genetic testing including TP53 mutations
5. Ig levels & direct antiglobulin test (haemolysis)
6. CT chest abdomen & pelvis (lymph nodes etc)

NOTE: Diagnose can often be made without a bone marrow biopsy

Question 6

What would you expect on a blood count & film of a patient with CLL

Answer 6

• High WCC
• Low or normal Hb & platelets (infiltration dependant)
• Smear cells on blood film

Question 7

What are smear cells & why do they occur

Answer 7

Occur during the process of preparing the blood film where aged or fragile white blood cells rupture and leave a smudge on the film

Question 8

Treatment is not always necessary in CLL. What are indications for treatment?

Answer 8

• weight loss of more than 10% over 6 months,
• night sweats for longer than 1 month,
• spleen or lymph node enlargement
• progressive marrow failure (anaemia or thrombocytopenia)

Question 9

A patient presents with autoimmune cytopenia. You treat her for this and also carry out other tests that identify high WCC & CLL. Other than her autoimmune cytopenia, she has no symptoms. Would you treat her CLL?

Answer 9

No, Autoimmune problems but no CLL symptoms ⇒ autoimmune treatment alone

Question 10

What is the main concerning complication of CLL

Answer 10

CLL can transform into high-grade B cell lymphoma