DR Medhat MRCP

Chronic Lymphocytic Leukemia (CLL)
- It is caused by a monoclonal proliferation of well-differentiated lymphocytes which
are almost always B-cells (99%)
• Features (age > 60 y)
Often none (discovered accidentally during routine CBC as leucocytosis in elderly)
Constitutional: anorexia, weight loss.
Bleeding, infections.
Lymphadenopathy (symmetrical) more marked than CML.
Painless enlargement of lacrimal & salivary glands
• Complications :
Hypogammaglobulinemia leading to recurrent
infections (eg pneumonia) most common cause of death
Warm autoimmune hemolytic anemia in 10-15% of patients.
Transformation to high-grade lymphoma
(Richter's transformation)
• Investigations :
Immunophenotyping (=flow cytmetry) .****
Blood film / smear (not always done) : smudge cells
Mickulicz
syndrome
CLL - immunophenotyping is investigation of choice
- Immunophenotyping will demonstrate the cells to be B-cells (CD19 positive).
- CD5 and CD23 are also characteristically positive in CLL
Panhypogamaglobuliemia e.g IgG↓
• Indications for treatment :
1) Progressive marrow failure :
- The development or worsening of anemia and/or thrombocytopenia.
2) Massive (>10 cm) or progressive lymphadenopathy.
3) Massive (>6 cm) or progressive splenomegaly.
4) Progressive lymphocytosis: > 50% over 2 months or lymphocyte doubling time < 6
..
5) Systemic symptoms: weight loss > 10% in previous 6 months, fever >38ºc for > 2
weeks , extreme fatigue, night sweats.
6) Autoimmune cytopenias e.g. ITP
خد بالك فيها خدعة كبيره فى السؤال انظر المالحظة فى المستطيل اللى تحت months
High absolute lymphocyte count is not an indication for TTT, rather than the rate of
50