Chronic Lymphocytic Leukemia - The Leukemia & Lymphoma Society

Signs and Symptoms
CLL symptoms usually develop over time. Early in the course of the disease, CLL
often has little effect on a person’s well-being. Some people with CLL do not have
any symptoms. The disease may be suspected because of abnormal results from
blood tests that were ordered either as part of an annual physical or a medical
examination for an unrelated condition. An elevated white cell (lymphocyte) count
is the most common finding that leads a doctor to consider a CLL diagnosis.
People with CLL who do have symptoms may tire more easily, and/or feel short
of breath during day-to-day physical activities—as a result of anemia (low red
cell count). They may lose weight because of decreased appetite and/or increased
use of energy. The lymph nodes and spleen may become enlarged as a result of
an accumulation of CLL cells (leukemic lymphocytes). Infections of the skin,
lungs, kidneys or other sites may occur as result of low immunoglobulin levels and
decreased neutrophil counts.
Diagnosis
Blood Cell Count and Examination. The diagnosis of CLL is usually evident
from the results of blood cell counts and an examination of blood cells. A person
with CLL will have increased numbers of lymphocytes. Low platelet counts and
low red cell counts may also be present; these counts are usually only slightly
decreased in the early stage of the illness.
Bone Marrow Examination. A bone marrow aspiration and biopsy generally are
not needed to make a diagnosis of CLL. However, these tests are recommended
before treatment begins—the test results provide baseline data that can confirm
other diseases are not present and also be used later on to evaluate the effects
of therapy. Repeat marrow biopsies are helpful in distinguishing disease versus
treatment-related causes of low blood cell counts that do not improve within an
expected period of time after treatment.
In people with CLL, a bone marrow examination will show an increase in the
number of lymphocytes in the marrow and often a decrease in the number of
normal marrow cells. The bone marrow biopsy results will also show one of four
patterns characteristic of CLL: nodular, interstitial, mixed or diffuse.
Immunophenotyping. “Immunophenotyping” (or flow cytometry) of
lymphocytes is an important process used to diagnose CLL, and other types of
leukemia and lymphoma, by comparing the cancer cells to normal immune cells.
The test results indicate whether or not the person’s lymphocytes are derived
from a single cancer cell (leukemia) or from other conditions in adults that can,
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