Chronic lymphocytic leukaemia (CLL)

Overview:

• Is an incurable disease of older people
• Is characterised by an uncontrolled proliferation and accumulation of mature B-cells (although T-cell CLL does occur)
• A proportion of patients remain asymptomatic, dying of an unrelated cause
• In the remainder, the disease can usually be kept under control for 9-10 years, infection being the predominant cause of death

Clinical features:

In asymptomatic patients, the diagnosis is often a chance finding on the basis of a blood count done for a quite different reason

Symptoms:

Recurrent infections (resulting from neutropenia and reduced Ig levels)

Symptoms of anaemia:

May develop rapidly in the context of haemolysis (usually precipitated by infection)

Painless lymph node enlargement

Signs:

• Signs of anaemia
• Lymph node enlargement
• Enlarged liver and/or spleen

Investigations:

FBC:

• Hb low or normal
• Raised WCC (of which at least 40% are lymphocytes)
• Platelets low or normal

Serum Igs:

• Low or normal

Coomb’s test:

• Positive if haemolysis is occurring

Treatment:

• The disease may remain stable for several years
• There is no advantage in starting treatment before there is a clinical indication:
• Anaemia
• Recurrent infections
• Bleeding
• ‘Bulky’ lymphadenopathy
• Increasing Splenomegaly

• Chlorambucil is most often used, with or without prednisolone
• Treatment is given intermittently, as and when necessary