Chronic lymphocytic leukemia is proliferation of normal B lymphocytes that function abnormally.
The WBC count in CLL is > 20,000/flL with 80-98% lymphocytes.
Smudge cells are seen in CLL.
Staging of CLL mnemonic
High LSAT score :D
Stage 0: High WBC
Stage 1: Lymphadenopathy
Stage 2: Splenomegaly + Hepatomegaly
Stage 3: Anemia
Stage 4: Thrombocytopenia
For stage 0 and stage 1, no treatment is required.
Therapy is indicated for patients with advanced stage disease, high tumor burden, severe disease-related "B" symptoms, or repeated infections.
Hepatosplenomegaly, anemia and thrombocytopenia are preferably treated with fludarabine and rituximab (FR).
For refractory cases, cyclophosphamide can be used (FCR regimen)
Older individuals (> 65 years of age) can be treated with ibrutinib, a bruton’s tyrosine kinase (BTK) inhibitor (preferred) or chlorambucil plus anti-CD20 monoclonal antibodies.
Autoimmune hemolysis or thrombocytopenia is treated with prednisone (Autoimmune warm IgG antibodies)
CLL has a good prognosis compared to other leukemias. Most common cause of death is due to infection.