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

http://learning.bmj.com/learning/module-intro/chronic-lymphocytic-leukaemia.html?locale=en_GB&page=1&moduleId=10030509&searchTerm=%E2%80%9Cleukaemia%E2%80%9D

http://calgaryguide.ucalgary.ca/slide.aspx?slide=Chronic%20Lymphocytic%20Leukemia.jpg