Chronic Lymphocytic Leukemia Initial Assessment

Clinical Presentation

Assess the patient’s performance status based on the clinical presentation. Patients may present with enlarged lymph nodes; systemic symptoms such as tiredness, fever, drenching night sweats, unintentional weight loss (≥10% in previous 6 months); and symptoms of anemia or infection. 

Chronic Lymphocytic Leukemia_Initial Assessment

Physical Examination

During a physical examination, take note of the node-bearing areas (eg Waldeyer’s ring) and look for palpable lymph nodes and signs of spleen or liver enlargement. Skin examination is also important; look for the presence of macules, papules, plaques, nodules, ulcers, and blisters.

Diagnosis or Diagnostic Criteria

The diagnosis of CLL is based on the following criteria: 

• Presence of monoclonal B-cell lymphocytes ≥5 x 10⁹/L in peripheral blood
• Clonality of circulating B lymphocytes confirmed by flow cytometry
• CLL cells are small, mature-looking lymphocytes with a narrow border of cytoplasm, dense nucleus with no visible nucleoli, and with partially aggregated chromatin
• Immunophenotype: CD5, CD19, and CD23; low CD20, CD79b, and FMC7 (typically negative); CD10 and cyclin D1 negative
  • LEF1 and SOX11 in cyclin D1-negative patients