Chronic Lymphocytic Leukaemia

Question 1

What occurs in CLL?

Answer 1

Progressive accumulation of a malignant clone of functionally incompetent B cells
Most common leukaemia in elderly and adults

Question 2

What are clinical features of CLL?

Answer 2

Often none - presents as finding on routine FBC
Anaemia
Anorexia
Weight loss
Bleeding
Ifnections

Enlarged, rubbery, non-tender nodes (Symmetrical)
Splenomegaly
Hepatomegaly

Question 3

What Ix in CLL?

Answer 3

Raised lymphocytes - lymphocytosis
Autoimmune haemolysis
Marrow infiltration:
Anaemia, Neutropenia, thrombocytopenia

Blood film: smudge/smear cells

Question 4

What are Rai stages of CLL?

Answer 4

0 - lymphocytosis alone
I - lymphocytosis + lymphadenopathy
II - lymphocytosis + spleno or hepatomegaly
III - lymphocytosis + anaemia
IV - lymphocytosis + platelets < 100x10^9

Worse prognosis

Question 5

What are complications of CLL?

Answer 5

Autoimmune haemoalysis
Infection due to hypogammaglobulinaemia (Low IgG)
- Herpes zoster
Marrow failure
Anaemia
Richter’s transformation - leukaemia cells enter lymph node and change into high-grade fast growing non-Hodgkin’s lymphoma
- Lymph node swelling, fever, weight loss, night sweats, nausea, abdo pain

Question 6

What is Mx in CLL?

Answer 6

Consider drugs if symptomatic
Fludarabine, rituximab, cyclophosphamide

Steroids help autoimmune haemolysis
Radiotherapy for lymphadenoapthy and splenomegaly

Supportive care:
Transfusions
IV human IgG

Question 7

What is the natural history in CLL?

Answer 7

1/3 never progress
1/3 progress slowly
1/3 progress actively