Table of Contents

Chronic Lymphocytic Leukemia

Chronic Lymphocytic Leukemia

Workup

Physical Exam
Baseline labs
Imaging: CT > PET
Repeat peripheral flow
Bone marrow biopsy
HBV, HCV (less important now that rituxamab falling out of favor)

Staging

Biret
- A: <3 lymphoid
- B: >3 lymphoid
- C: Hgb < 10 or platelets < 100
Rai
- 0: lymphocytosis
- I: lymphadenopathy
- II: hepatosplenomegaly
- III: Hgb < 11
- IV: platelets < 100

Diagnosis

B cells > 5 x 10^9
lymphadenopathy or splenomegaly
cytopenia
CLL-related symptoms

if meets bottom three criteria, then small lymphocytic lymphoma

Treatment

first-line
- ibutrinib (BTK inhibitor)
  - adverse effects: diarrhea, rash, bleeding, atrial fibrillation
- venetoclax (now 1st line)
refractory:
- idelalisib
- immunotherapy
  - allo-SCT
  - CAR-T
  - lenalidomide
  - checkpoint inhibitors

Indications

Bone marrow failure: Hgb < 11, platelets < 100
Symptoms
- weight loss >10% over 6 months
- ECOG ≥ 2
- T ≥ 38°C for 2 weeks
- night sweats
Splenomegaly (>6 cm or symptomatic)
Lymphadenopathy (>10 cm or symptomatic)
Progression of disease
- ALC increase >50% in 2 months
- ALC doubling time <6 months

Complications

infection
autoimmune (5-10%)
- AIHA
- ITP
pure red cell aplasia
malignancy
- DLBCL
- Skin: 5-10x risk SCC/BCC

Poor prognostic factors

17p13 deletion
11q22.3
Trisomy 12
13q14
NOTCH, SF3D1?
hypermutation?
beta-2 macroglobulin