Chronic Lymphocytic Leukemia (CLL) Clinical Presentation

Updated: Feb 08, 2022
  • Author: Mohammad Muhsin Chisti, MD, FACP; Chief Editor: Emmanuel C Besa, MD  more...
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History and Physical Examination

Patients with chronic lymphocytic leukemia (chronic lymphoid leukemia, CLL) present with a wide range of symptoms and signs. Onset is insidious, and it is not unusual for CLL to be discovered incidentally after a blood cell count is performed for another reason; 25-50% of patients will be asymptomatic at time of presentation.

Enlarged lymph nodes are the most common presenting symptom, seen in 87% of patients symptomatic at time of diagnosis. A predisposition to repeated infections such as pneumonia, herpes simplex labialis, and herpes zoster may be noted. Early satiety and/or abdominal discomfort may be related to an enlarged spleen.

Mucocutaneous bleeding and/or petechiae may be due to thrombocytopenia. Tiredness and fatigue may be present secondary to anemia; 10% of patients with CLL will present with an autoimmune hemolytic anemia.

Richter syndrome or Richter transformation refers to the transformation of CLL into an aggressive large B-cell lymphoma and is seen in approximately 3-10% of cases. Patients will often present with symptoms of weight loss, fevers, night sweats, muscle wasting, (ie, B symptoms) and increasing hepatosplenomegaly and lymphadenopathy. Treatment remains challenging and prognosis poor, with median survival in months.

Physical examination

In addition to localized or generalized lymphadenopathy, patients may manifest the following:

  • Splenomegaly (30-54% of cases)
  • Hepatomegaly (10-20% of cases)
  • Petechiae
  • Pallor