Chronic Lymphocytic Leukaemia (CLL)

Question 1

What is CLL?

Answer 1

monoclonal proliferation of well-differentiated lymphocytes

(almost always B-cells)

Question 2

Features of CLL

Answer 2

Asymptomatic
weight loss
bleeding, infections
lymphadenopathy

Question 3

Investigation findings in CLL

Answer 3

FBC
- lymphocytosis
- anaemia
- thrombocytopenia

blood film
- smudge/smear cells

immunophenotyping
- specific for CD5, CD19, CD20 and CD23

Question 4

Poor prognostic factors in CLL

Answer 4

male
> 70 years
lymphocyte count > 50
>10% immature lymphocytes
lymphocyte doubling time < 12 months
raised LDH
CD38 expression positive
TP53 mutation

Question 5

Chromosome change associated with good prognosis

Answer 5

deletion of the long arm of chromosome 13 (del 13q)

Question 6

Chromosome abnormality associated with poor prognosis

Answer 6

deletions of part of the short arm of chromosome 17 (del 17p)

Question 7

Indications for treatment of CLL

Answer 7

• marrow failure
• massive lymphadenopathy or splenomegaly
• progressive lymphocytosis
• systemic symptoms:
  > weight loss
  > fever
  > extreme fatigue
  > night sweats
  > ITP

Question 8

Initial treatment of choice for CLL

Answer 8

• fludarabine, cyclophosphamide and rituximab (FCR)

Question 9

Second line therapy

Answer 9

ibrutinib

Question 10

Complications of CLL

Answer 10

• anaemia
• hypogammaglobulinaemia
  => recurrent infections
• warm AIHA
• RIchter’s transformation to high-grade lymphoma

Question 11

What is Richters transformation?

Answer 11

leukaemia cells enter the lymph node and change into a high-grade, fast-growing non-Hodgkin’s lymphoma.

Question 12

Symptoms of Richter’s Transformation

Answer 12

lymph node swelling
fever without infection
weight loss
night sweats
nausea
abdominal pain