Leukaemia, Chronic Lymphocytic (CLL)

Question 1

Define

Answer 1

DEFINITION: characterised by progressive accumulation of functionally incompetent lymphocytes, which are monoclonal in origin. There is an overlap between CLL and non-Hodgkin’s lymphoma

Question 2

Causes

Answer 2

Malignant cells may accumulate as a result of their inability to undergo apoptosis

The most common chromosomal changes include:

• Trisomy 12
• 11q and 13q deletions

Question 3

Epidemiology

Answer 3

90% are > 50 yrs

More common in MALES

Rare in Asians

Question 4

Symptoms

Answer 4

Asymptomatic - 40-50% of cases are diagnosed following routine blood tests

Systemic Symptoms:

• Lethargy
• Malaise
• Night sweats

Symptoms of Bone Marrow Failure:

• Recurrent infections
• Herpes zoster infection
• Easy bruising or bleeding

Question 5

Signs

Answer 5

Non-tender lymphadenopathy

Hepatomegaly

Splenomegaly

LATE STAGE signs of bone marrow failure:

• Pallor
• Cardiac flow murmur
• Purpura/ecchymosis

Question 6

Investigations

Answer 6

NOTE: CLL may be associated with autoimmune phenomena such as haemolytic anaemia (warm agglutinins) or thrombocytopaenia

• Bloods

FBC

Lymphocytosis

Low Hb

Could be due to bone marrow infiltration, hypersplenism or autoimmune haemolysis

Low platelets

Low serum Ig

• Blood Film

Small lymphocytes with thin rims of cytoplasm

Smudge cells

• Bone Marrow Aspirate or Biopsy

Lymphocytic replacement of normal marrow

• Cytogenetics