Chronic Lymphocytic Leukemia - Summary Cancer affecting lymphocytes/Mature B cell neoplasm • Lymphocytes accumulate in large numbers and are dysfunctional rendering the immune system incompetent • CLL is identical to the non-Hodgkin lymphoma SLL CLL Epidemiology: • Most common leukemia in adults in the west • M > F • Affects mainly older adults • Exposure to Agent Orange or Hep C Clinical Presentation: • Many with no early symptoms • Lymphadenopathy • Fevers > 100.5 for > 2 weeks without infection • Drenching night sweats • Extreme fatigue Physical Exam/Signs: • Lymphadenopathy • Splenomegaly • Hepatomegaly • Skin: - CLL cells can infiltrate any organ. - Leukemia cutis involves face: macules, papules, plaques, nodules, ulcers, blisters. • MPGN: Paraneoplastic phenomenon CLL Diagnosis: • Lymphocytosis on CBC • Confirm: Flow cytometry • Peripheral smear: Smudge cells or basket cells can indicate disease • B cell surface molecules: CD5 and CD23 antigen • Matute’s CLL Scoring system: DDX between classical CLL and other C Cell lymphoproliferative disorders. CLL Labs: 1. Lymphocytosis: Absolute blood lymphocyte > 5000/microL 2. Cytopenias: • Neutropenia, anemia, thrombocytopenia • AIHA • Pure red cell aplasia • ITP • Agranulocytosis 3. Immunoglobulin abnormalities: • Hypogammaglobulinemia • Polyclonal increase in gamma globulins 4. Elevated LDH 5. Elevated beta 2 microglobulin Treatment: • Bruton's tyrosine kinase (BTK) Complications: • Hypogammaglobulinemia • Warm AIHA • Bone marrow failure • Richter’s Syndrome: Transform to DLBCL, PML leukemia, Hodgkin’s lymphoma or acute leukemia • GI complications: Intussusception, SIB Contamination, colitis DDX: • Follicular lymphoma • Marginal zone lymphoma • Mantle cell lymphoma • Lymphoplasmacytic lymphoma • Hairy cell leukemia • Prolymphocytic leukemia • Sezary syndrome • Smoldering adult T cell leukemia #CLL #Chronic #Lymphocytic #Leukemia #diagnosis #workup #oncology #hematology
