Chronic Lymphocytic Leukaemia

Question 1

What is chronic lymphocytic leukaemia?

Answer 1

Chronic proliferation of a single lymphocyte (usually B cell)

Main issue is impaired apoptosis, not inc production!!

Question 2

Who gets CLL?

Answer 2

Common in age 60+ (older than CML patients)

Question 3

Pathophysiology of CLL

Answer 3

Main hallmark is IMPAIRED APOPTOSIS rather than EXCESS PRODUCTION

Low grade (less primitive cells)

Question 4

Clinical presentation of CLL

Answer 4

Often can be totally asymptomatic

Many non specific symptoms:
Infections due to immunocompromisation
Anaemia
Bleeding
Weight loss and night sweats
Fever and fatigue
Maybe Splenomegaly

MAY ALSO CAUSE warm autoimmune haemolytic anaemia

Question 5

Investigations for CLL

Answer 5

FBC- very high WBC, Hb may be low, thrombocytopenia develops in late stage
Blood film- high lymphocytes and SMEAR/SMUDGE CELLS- (rupture of fragile cells on film)
DAT- direct antibody test
Coombs for haemolysis
Genetics- 13q delete or trisomy 12 are common

Bone marrow aspirate would show lymphocytic infiltration, but its not always required

Question 6

Management for CLL

Answer 6

Depends on stage of disease- if red flag symptoms are accelerated then treat

Anti-CLL therapy:
Targeted treatment eg kinase or BCL-2 inhibition
Note side effects- may inhibit platelets and have arrhythmia association

Question 7

Name a complication of CLL

Answer 7

Richters transformation:

It’s possible chronic lymphocytic leukaemia can become a more severe lymphoma, like diffuse large B-cell lymphoma