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Overview
Chronic lymphocytic leukemia (CLL) is a chronic
lymphoproliferative disorder characterized by the progressive accumulation of
monoclonal B-cell lymphocytes found in the blood and bone marrow as stated in the
Introduction section.
CLL is the most common form of adult leukemia in the Western
world while in the Asian countries, its incidence is low. Incidence and prevalence
of the disease worldwide and regionally can be found in the Epidemiology section.
The development of CLL involves processes that lead to the
clonal replication of malignant B lymphocytes in the blood, bone marrow, lymph
nodes, and the spleen. These processes are discussed in the Pathophysiology section.
The Risk
Factors section discusses the different factors that can
contribute to the development of CLL such as family history, and the genetic
aberrations commonly associated with this disease.
History and Physical Examination
The Clinical Presentation
section enumerates the manifestations of CLL that are essential to assess the
patient’s performance status.
As stated in the Physical
Examination section, lymph nodes palpation and skin examination
are essential parts of assessing patients suspected to have CLL.
Diagnosis
Essential and optional tests to assess patients suspected of
having CLL are enumerated and discussed in the Laboratory
Tests and Ancillaries and
Imaging sections. Among these
are biopsy, immunophenotyping and serum markers.
Blood tests and immunophenotyping are essential in
concluding the diagnosis of CLL. Basis of diagnosing CLL are enumerated in the Diagnosis or Diagnostic Criteria section.
The Differential
Diagnosis section enumerates the diseases that may mimic CLL, and
these should be ruled out.
Management
The Evaluation
section mentions the Rai and Binet systems of staging CLL. Functional status
evaluation scoring systems used are enumerated in this section.
The choice of treatment for patients with CLL is based on
the disease stage, presence or absence of del(17p) or TP53 mutation,
patient’s age, functional status, presence or absence of comorbidities, and IGHV
mutation status. Criteria for choosing treatment, indications for initiation of
treatment, and therapeutic recommendations are discussed in the Principles of Therapy section.
The Pharmacological Therapy
section includes the discussion of drug options used in patients
with CLL. This includes alkylating agents, monoclonal antibodies and other
neoplastic agents. It also has discussion on chemotherapeutic regimens, second-
and third- line therapies and supportive therapies.
Recommendations for patients who will undergo observation
are enumerated in the Nonpharmacological section.
Tests and assessments to be done in surveillance
of patients with CLL are in the Monitoring
section.
