Chronic Lymphocytic Leukaemia (CLL)

Mnemonic

• LSAT (used for Rai scoring system as well as signs/symptoms) Rai scoring system
  • Stage 0: High WBC  Stage 1: Lymphadenopathy Stage 2: Splenomegaly + Hepatomegaly  Stage 3: Anemia Stage 4: Thrombocytopenia

Introduction

• Progressive accumulation of malignant clone of functionally incompetent B-lymphocytes (abnormal proliferation of abnormal cells)
• affects older patients (in 60s )

Signs and symptoms

• Constitutional symptoms but can have no signs
• Signs as per mnemonic above

Tests

• High lymphocytes
• Later: autoimmune haemolysis
• Marrow infiltration causes: anaemia, decreased neutrophils and platelets (as per mnemonic)

Complications

• Autoimmune haemolysis.
• ↑Infection due to low WCC (=↓IgG), bacterial, viral especially herpes zoster
• Marrow failure

Natural history

• ⅓ never progress (or even regress), ⅓ progress slowly, and ⅓ progress actively
• Death is often due to infection or transformation to aggressive lymphoma (Richter’s syndrome)

Management

• Chemotherapy if symptomatic
• Radiotherapy for lymphoadenopathy and splenomegaly
• Steroid for autoimmune haemolysis
• Stem cell transplantation in selected patients
• Supportive: transfusion