Tuesday, 6 May 2014

Chronic Lymphocytic Leukaemia

There are two types of "chronic" leukaemia. The pathophysiology and clinical features are different - so I'll look at CLL to start with. As always, the Calgary Guide has the best overview. 


Epidemiology
- 3/4 of patients are > 55 years old
- Less than 2% are younger than 45 years old. 
- >20 per 100,000 over 70 years old
- Twice as common in men as women
- Most common in Western White and black populations
- Strongest risk factor is FHx 

Small Lymphocytic Lymphoma
- Same disease, but in the lymph nodes rather than the blood.

Clinical Features
-  80% are asymptomatic
- Painless, often symmetrical lymphadenopathy, splenomegaly, or hepatomegaly. 
- In the latter stages of the disease patients may have anaemia, neutropenia, or thrombocytopenia due to bone marrow failure. 

Investigations
- Raised lymphocytes (lymphocytosis)
- Classified by Rai and Binet systems. 

Treatment
- To slow progression, and for palliation. 

Complications
Infections - bacterial, and viral
Anaemia - bone marrow suppression, or secondary to autoimmune haemolytic anaemia, red cell aplasia, 
Bleeding - bone marrow suppression or immune thrombocytopenia
Transformation- Richter's transformation into CLL. Symptoms of weight loss, fevers, night sweats, muscle wasting, and increasing hepatosplenomegaly and lymphadenopathy. 

References

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