Chronic Lymphocytic Leukemia
Definition
Clonal disorder of a pluripotent stem cell.
Signs & Symptoms
Symmetrical enlargement of cervical, axillary / inguinal lymph nodes. The nodeas are discrete and non-tender. Features of anemia and thrombocytopenia may be present.
Risk Factors
Most common between 60 – 80 years old and male to female ratio of 2:1. Common in the Western world.
Causes
Relatively mature B cell with weak surface expression of IgM / IgD cells accumulate in the blood, bone marrow, liver, spleen and lymph nodes as a result of prolonged lifespan with impaired apoptosis.
Peripheral blood characteristics
Lymphocytosis with small lymphocytes. Smudge or smear cells may be present. Normochormic normocytic anemia due to marrow infiltration or hypersplenism.
Bone marrow characteristics
Lymphocytosis, with nodular, diffuse or interstitial involvement by lymphocytes.
Important investigations & related results
Immunophenotyping will show B cells with CD19+, Cd5+, CD23+, CD79b- and FMC7-. Reduced serum immunoglobulin concentration. Cytogenetics will reveal deletion of 13q14, trisomy 12, deletions at 11q23, structural abnormalities of 17p involving the p53 gene.
Staging
Rai (0 – IV) and Binet (A-C)
Treatment & management
Symptomatic, chemotherapy (e.g. chlorambucil), purine analogues, monoclonal antibodies and corticosteroids.
Peripheral blood smear in CLL
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