Chronic Lymphocytic Leukemia - The Leukemia & Lymphoma Society

Prolymphocytes. About 15 percent of people with CLL have leukemia cells that
are a mix of lymphocytes and another type of white cell, called a “prolymphocyte”
(see Figure 3, Panel D). Most people with this type of CLL follow a similar
course to that of other people with CLL. However, for a relatively small subset of
patients with this type of CLL, the blood cells may become mainly composed of
prolymphocytes; the spleen may enlarge further, and the disease may become less
responsive to treatment. In these cases, individuals are encouraged to talk to their
doctors about the potential benefits of treatment in a clinical trial.
Lymphocytes
Panel A Panel B
Panel C
Panel D
Figure 3. I Panel A shows a normal lymphocyte in the blood film of a healthy person. Panel B shows the
increased frequency of lymphocytes in the blood film of a patient with CLL. Panel C shows the appearance
of large granular lymphocytes in a patient with large granular lymphocytic leukemia (the arrows point to the
cluster of granules in the cells), and Panel D shows the cells of prolymphocytic leukemia, which are larger than
those in Panels A and B and have a light area in their nucleus, called a “nucleolus” (see arrow). This structure in
the nucleus is a sign of a more immature or primitive cell.
Autoimmune Hemolytic Anemia. Some people with CLL produce a type of
antibody that works against their own cells. These “autoantibodies” are usually
directed against the patient’s red cells and causes them to be removed rapidly
from the blood. This condition, called “autoimmune hemolytic anemia,” can
worsen the effects of already low red cell counts. The “antiglobulin test” or
“Coombs’ test” is used to identify the autoantibodies. Less often, the antibody
works against the platelets. This condition, called “immune thrombocytopenia,”
Chronic Lymphocytic Leukemia I page 19