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Sections Chronic Lymphocytic Leukemia (CLL)
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Guidelines
- Medication
- Questions & Answers
- Media Gallery
- Tables
- References
History and Physical Examination
History
Patients with chronic lymphocytic leukemia (chronic lymphoid leukemia, CLL) present with a wide range of signs and symptoms. The onset is insidious, and it is not unusual for CLL to be discovered incidentally after a blood cell count is performed for another reason. Up to 80% of patients are asymptomatic at the time of diagnosis. [23]
Enlarged lymph nodes are the most common presenting sign in symptomatic patients. A predisposition to repeated infections such as pneumonia, herpes simplex labialis, and herpes zoster may also be seen. 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; up to 10% of patients with CLL will present with an autoimmune hemolytic anemia. [2]
Richter syndrome or Richter transformation refers to the transformation of CLL into an aggressive large B-cell lymphoma and is seen in approximately 17% of high-risk patients. [2] Patients will often present with a constellation of "B symptoms", including weight loss, fevers, night sweats, and muscle wasting, as well as increasing hepatosplenomegaly and lymphadenopathy. Treatment remains challenging and prognosis is poor, with median survival of a few months.
Physical Examination
In addition to localized or generalized lymphadenopathy, patients may manifest the following:
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Splenomegaly (30-54% of cases)
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Hepatomegaly (10-20% of cases)
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Petechiae
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Pallor
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Peripheral smear from a patient with chronic lymphocytic leukemia, small lymphocytic variety.
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Peripheral smear from a patient with chronic lymphocytic leukemia, large lymphocytic variety. Smudge cells are also observed; smudge cells are the artifacts produced by the lymphocytes damaged during the slide preparation.
Tables
| CLL-IPI category | Overall Survival at 5 years | Treatment Recommendation |
|---|---|---|
| Low risk | 93.2% | Do not treat |
| Intermediate risk | 79.3% | Treat only if symptomatic |
| High risk | 63.3% | Treatment indicated; however, can consider no treatment if asymptomatic |
| Very high risk | 23.3% | If treatment needed, do not use chemotherapy; instead, use targeted agent or clinical trial |
Mohammad Muhsin Chisti, MD, FACP Associate Professor of Medicine (Hematology and Oncology), Oakland University William Beaumont School of Medicine; Medical Director of Research, Karmanos Cancer Institute
Mohammad Muhsin Chisti, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, Medical Society of the State of New York
Disclosure: Nothing to disclose.
Bilal M Ali, BS MD Candidate, Oakland University William Beaumont School of Medicine
Disclosure: Nothing to disclose.
Emma L Herrman, MD Resident Physician, Department of Internal Medicine, Beaumont Hospital
Emma L Herrman, MD is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American College of Physicians
Disclosure: Nothing to disclose.
Mariam Aoun, MD Resident Physician, Department of Internal Medicine, Beaumont Hospital – Royal Oak
Disclosure: Nothing to disclose.
Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences
Disclosure: Nothing to disclose.
Karen Seiter, MD Professor, Department of Internal Medicine, Division of Oncology/Hematology, New York Medical College
Karen Seiter, MD is a member of the following medical societies: American Association for Cancer Research, American College of Physicians, American Society of Hematology
Disclosure: Received honoraria from Novartis for speaking and teaching; Received consulting fee from Novartis for speaking and teaching; Received honoraria from Celgene for speaking and teaching.
Haleem J Rasool, MD, FACP Chair, Department of Oncology, Mayo Clinic Health System, La Crosse, WI
Haleem J Rasool, MD, FACP is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, American Society of Hematology
Disclosure: Nothing to disclose.
Delong Liu, MD, PhD Professor of Medicine, Division of Oncology/Hematology, New York Medical College; Chief of Hematology, Phelps Memorial Hospital Center; Director of Non-ablative Allogeneic Stem Cell Transplantation Program, Westchester Medical Center; Editor-in-Chief, Journal of Hematology and Oncology
Delong Liu, MD, PhD is a member of the following medical societies: American Society of Hematology, American Society of Clinical Oncology
Disclosure: Nothing to disclose.
Samir C Patel, MD Fellow, Department of Hematology and Medical Oncology, Metropolitan Hospital, New York Medical College
Disclosure: Nothing to disclose.
Muhammad A Mir, MD, FACP Assistant Professor of Medicine (Hematology, Blood/Marrow Transplant) Milton S Hershey Medical Center, Pennsylvania State University College of Medicine
Muhammad A Mir, MD, FACP is a member of the following medical societies: American College of Physicians, American Society of Hematology, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology
Disclosure: Nothing to disclose.
Michael Perry, MD, MS, MACP† Former Nellie B Smith Chair of Oncology Emeritus, Former Director, Division of Hematology and Medical Oncology, Former Deputy Director, Ellis Fischel Cancer Center, University of Missouri-Columbia School of Medicine
Clarence Sarkodee-Adoo, MD Consulting Staff, Department of Bone Marrow Transplantation, City of Hope Samaritan BMT Program
Disclosure: Takeda Millenium Honoraria Speaking and teaching
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Salary Employment
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Sections Chronic Lymphocytic Leukemia (CLL)
- Overview
- Presentation
- DDx
- Workup
- Treatment
- Guidelines
- Medication
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