CLL

Question 1

What is CLL?

Answer 1

Monoclonal proliferation of well differentiated lymphocytes (almost always B cells)

Question 2

What are the presenting features of CLL?

Answer 2

Anorexia, weight loss
Bleeding
Infection
Lymphadenopathy (more marked than in CML)

Question 3

What is seen on bloods in CLL?

Answer 3

Lymphocytosis
Anaemia - either AIHA or bone marrow replacement
Thrombocytopenia

Question 4

What is seen on blood film in CLL?

Answer 4

Smudge/smear cells

Question 5

How is CLL diagnosed?

Answer 5

Immuphenotyping

Question 6

What are indications for treatment in CLL?

Answer 6

Progressive bone marrow failure
Massive/progressive lymphadenopathy (>10cm)
Massive/progressive splenomegaly (>6cm)
>50% increase in lymphocytes over 2 months
Lymphocyte doubling time <6 months
Systemic symptoms
Autoimmune cytopenias

Question 7

What is the management of CLL?

Answer 7

Fludarabine, cyclophosphamide, Ritux

Question 8

What genetics are associated with poor prognosis in CLL?

Answer 8

del 17p

Question 9

What genetic mutation is associated with good prognosis in CLL?

Answer 9

del 13q

Question 10

What are poor prognostic indicators in CLL?

Answer 10

> 70yo
Male
Lymphocyte count >50
Lymphocyte doubling time <12 months
Raised LDH
CD38 +
TP 53 mutation

Question 11

What are common complications of CLL?

Answer 11

Anaemia
Warm AIHA
Hypogammaglobulinaemia
Richter’s transformation

Question 12

What is Richter’s transformation?

Answer 12

CLL transformation to high grade lymphoma