Outline

Background

• Cancer of lymphoid progenitor cell, precursor to lymphocytes

• Translocation t11:14

• Prognosis: CLL is not curable but usually requires a watch and wait approach with mild treatment coming after many years

Assessment

Presentation

• Often asymptomatic

• Gradual decline

• Night sweats, fevers, weight loss, lymphadenopathy

Examination

• Lymphdenopathy- cervical, auxilla or groin

• Splenomegaly (commonest cause with Myelofibrosis )

Investigations

• Raised lymphocytes (and subsequently WCC)

• Peripheral blood immunotyping (shows malignancy lymphocytes)

• Bone marrow failure: Anaemia, Thrombocytopenia, Neutropenia

Diagnosis

Diagnostic criteria: peripheral blood immunotyping

Classification

• Severity markers: 

  • Lymphocyte doubling time < 6 months

  • Painful lymphadenopathy

  • Bone marrow failure: Anaemia, Thrombocytopenia, Neutropenia

  • Frailty

Management

Chronic 

1. Watch & Wait

2. Chemotherapy

   • BTK inhibitors: oral tablets for life- Zanubrutinib, Acalbrutinib

   • Ven-Obi (Venetocla-Obinutuzumab): 2 year stat

3. Supportive measures

   • Blood transfusions: aim Hb > 80 or when symptomatic < 90

   • Platelets for thrombocytopenia

   • GSF for neutropenia

Haem Reg Notes

Markers of increased severity

• TP53 gene- tumour suppression deletion

• Increased B2M (beta-2microglobulin): reflect disease stage and tumour burden

• Impaired renal function

• Elevated thymidine kinase

• 17p(del) on chromosome typing

Management

Indication to start chemotherapy: 

• Weight loss > 10%

• Extreme fatigue; fevers, night sweats

• Bone marrow failure

• AI anaemia or thrombocytopenia not responding to steroids

• Progressive splenomegaly

• Massive lymphadenopathy 

• Lymphocyte increase > 50% in less than 6 months

Chemotherapy: 

• Fludarabine regimes

• Initially up to 80% respond

No evidence that early treatment improves outcomes. 

Cause of Anaemia

1. Bone marrow infiltration (more commonly than haemolysis)

2. Haemolysis

Resources and References

Written in 2025.