№ 15Hematology15 min read
Chronic lymphocytic leukemia
1. Big picture
Chronic lymphocytic leukemia (CLL) is the classic leukemia of elderly patients: slow, indolent, often discovered incidentally on complete blood count (CBC) as persistent lymphocytosis. The oral exam pattern is:
Older patient + lymphocytosis + small mature lymphocytes + smudge/Gumprecht shadows + painless lymphadenopathy ± splenomegaly + low immunoglobulins → think CLL.
The examiner mainly wants you to know:
- Diagnosis is usually from peripheral blood flow cytometry, not bone marrow biopsy.
- CLL cells are mature-looking but functionally abnormal B cells.
- Do not treat early asymptomatic CLL — use watch and wait.
- Treat only if there is active/progressive/symptomatic disease.
- Prognosis depends strongly on TP53/17p deletion, IGHV mutation status, FISH findings, stage, and lymphocyte doubling time.
- Major complications are infections, autoimmune cytopenias, hypogammaglobulinemia, secondary cancers, and Richter transformation.
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