Chronic Lymphocytic Leukaemia

Question 1

What is CLL?

Answer 1

progressive accumulation of functionally incompetent lymphocytes, which are monoclonal in origin.
There is an overlap between CLL + non-Hodgkin’s lymphoma

Question 2

Describe the aetiology of CLL

Answer 2

Malignant cells may accumulate as a result of their inability to undergo apoptosis
The most common chromosomal changes include:
Trisomy 12
11q + 13q deletions

Question 3

Describe the epidemiology of CLL

Answer 3

90% are > 50 yrs
M > F
Rare in Asians
Commonest leukaemia

Question 4

List 3 systemic symptoms of CLL

Answer 4

Lethargy
Malaise
Night sweats

Question 5

List 3 symptoms of bone marrow failure in CLL

Answer 5

Recurrent infections
Herpes zoster infection
Easy bruising or bleeding

Question 6

How may CLL often present?

Answer 6

Asymptomatic: 40-50% of cases are diagnosed following routine blood tests

Question 7

List 3 signs of CLL

Answer 7

Non-tender lymphadenopathy: enlarged, rubbery
Hepatomegaly
Splenomegaly

Question 8

List 3 late signs of CLL due to bone marrow failure

Answer 8

Pallor
Cardiac flow murmur
Purpura/ecchymosis

Question 9

What may CLL be associated with?

Answer 9

AI phenomena e.g. haemolytic anaemia (warm agglutinins) or thrombocytopaenia

Question 10

What bloods are seen in CLL?

Answer 10

Lymphocytosis
Low Hb (indicates poor prognosis): due to BM infiltration, hypersplenism or AI haemolysis
Low platelets: marrow infiltration (indicates poor prognosis)
Low serum Ig: marrow infiltration (indicates poor prognosis)
Low neutrophils: marrow infiltration (indicates poor prognosis)
Later: AI haemolysis

Question 11

What is seen on blood film in CLL?

Answer 11

Small lymphocytes with thin rims of cytoplasm

Smudge cells

Question 12

What investigations may be considered in CLL?

Answer 12

FISH: identify cytogenic abnormalities
CT scan: identify hepatosplenomegaly + adenopathy
Bone Marrow Aspirate or Biopsy: Lymphocytic replacement of normal marrow