Chronic lymphoblastic leukaemia (CLL)

• What is the most common form of leukaemia found in older adults in Western countries?

  CLL
• What sex is CLL more common in?

  Males
• What are the main risk factors for CLL?

  Genetics

  Family history

  Immunosuppressed
• How may a patient with CLL present?

  Systemic symptoms

  Fatigue

  Lymphadenopathy

  Hepato/splenomegaly

  Bone marrow failure

  ITP
• What are the first-line investigations for CLL?

  FBC

  Blood film
• What is a characteristic feature of CLL found on a blood film?

  Smudge cells
• What would a FBC reveal for CLL?

  Lymphocytosis
• What is the gold standard for diagnosing CLL?

  Immunophenotyping by flow cytometry
• What are some further investigations for CLL?

  Immunophenotyping by flow cytometry

  Bone marrow aspiration/biopsy

  Cytogenic analysis
• What is used in the UK for CLL staging?

  Binet staging
• What is stage A of the Binet staging?

  Hb >10

  Platelets >100 x 109/L

  <3 Lymph node areas involved
• What is stage B of the Binet staging?

  Hb and platelets same as A

  3+ lymph node areas involved
• What is stage C of the Binet staging?

  Hb <10

  Platelets <100 x 109/L
• How is early CLL managed?

  Watch and wait strategy
• When is chemotherapy given to CLL patients?

  Active, symptomatic disease
• What does NICE advise for the first-line treatment for previously untreated CLL?

  Fludarabine, cyclophosphamide and rituximab (FCR)
• What does NICE advise for the first-line treatment for CLL (Binet stage B or C) if FCR is not appropriate?

  Chemo with bendamustine
• What are the main complications caused by CLL?

  Recurrent infections

  Anaemia

  Hyperviscosity syndrome

  Turn into other types of lymphoma (Richters transformation)
• What are some patient-related factors that can affect the prognosis of CLL?

  Age

  Gender