Chronic lymphocytic leukaemia

Dr Owen Kang and Dr Yuranga Weerakkody et al.

Chronic lymphocytic leukaemia (CLL) is a haematological malignancy

Epidemiology

CLL is considered the most common type of leukemia in the Western hemisphere; its prevalence in Europe and North America ranges from 29-38% of all leukaemias 1. It primarily affects adults ~65-70 years of age 3.

Clinical presentation

Up to half of patients can be asymptomatic with the disease being incidentally discovered by a routine blood work up 3. Patients may sometimes present with hepatomegaly, splenomegaly or both and/or a haemolytic anaemia.

Pathology

It is a B-lineage neoplasm of pre-follicular center cells that is usually associated with circulating neoplastic small lymphocytes. From a morphologic and immunophenotypic perspective, the malignant cells of CLL tend to be identical to those of nodal-based small lymphocytic lymphoma (SLL), and these two malignancies are thought to represent different manifestations of the same disease 1.

Staging

There are two common staging system in use which are:

Diagnosis

The diagnosis is generally established by a bone marrow biopsy and immunophenotyping.

Radiographic features

Imaging may identify various features of the disease such as splenomegaly, hepatomegaly +/- lymphadenopathy, although these are not specific for the disease.

MRI

As other type of bone marrow infiltrative disease, it is possible to see a diffusely hypointense signal of bone structures on T1, easier to see on spinal MRI.

Complications

  • Richter transformation: is defined as a diffuse large cell lymphoma, occurring by transformation of chronic lymphocytic leukemia 2,4.

See also

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