Chronic lymphocytic leukaemia (CLL)

Question 1

What is CLL?

Answer 1

Occurs when there is chronic proliferation of a single type of well differentiated lymphocyte. Usually B lymphocytes.

Question 2

CLL usually causes proliferation of T lymphocytes. True/false?

Answer 2

False

Usually B lymphocytes

Question 3

Aetiology of CLL?

Answer 3

Usually affects adults over 55 years old.

Question 4

Clinical features of CLL?

Answer 4

Often asymptomatic

Can present with infections, anaemia, bleeding and weight loss.

Can cause warm autoimmune haemolytic anaemia

Question 5

Blood test investigations for CLL?

Answer 5

Bloods:

• Blood count: Hb normal or low; increase in WCC, platelets can be normal or low.
• Blood film: increase in lymphocytes i.e. > 5x10^9/L
  * May show “smear” or “smudge” cells - occur during the process of preparing the blood film where aged or fragile white blood cells rupture and leave a smudge on the film.

Question 6

Bone marrow investigations for CLL?

Answer 6

• Similar to peripheral blood; may be heavily infiltrated with lymphocytes.
• Immunophenotyping - mainly CD19/20 and CD5 B cells which may weakly express surface immunoglobulins.
• Cytogenetics - e.g. deletion of 13q (most common), trisomy 12.

Question 7

Other investigations of CLL?

Answer 7

• Coombs’ test - may be positive if there is haemolysis
• Immunoglobulins - may be low or normal

Question 8

Management of CLL?

Answer 8

• Depends on the stage of the disease
• Chemotherapeutic interventions in early-stage disease is not usually necessary.

Question 9

What are the absolute indications for treatment in CLL?

Answer 9

Weight loss of more than 10% over 6 months

Night sweats for longer than 1 month

Progressive marrow failure (anaemia or thrombocytopenia)

Question 10

What is the main complication of CLL?

Answer 10

CLL can transform into high-grade lymphoma

Question 11

What are the key features of each of the leukaemia types?

Answer 11

ALL is the most common leukaemia in children and is associated with Down syndrome

CLL is associated with warm haemolytic anaemia, Richter’s transformation and smudge cells

CML has three phases, including a long chronic phase, and is associated with the Philadelphia chromosome

AML may result in a transformation from a myeloproliferative disorder and is associated with Auer rods

Question 12

What are smudge cells in CLL?

Answer 12

Remnants of cells that lack any identifiable cytoplasmic membrane or nuclear structure. They are damaged white blood cells that suggest the blood cells are more fragile.

Question 13

What is Richter’s transformation in CLL?

Answer 13

When the CLL changes (transforms) into a rare type of non-Hodgkin lymphoma, usually diffuse large B cell lymphoma.

This has a poor prognosis with ~ 10 months survival