Chronic Lymphocytic Leukemia

65 y/o white male with h/o previous radiation treatment presents with new onset fatigue. Reports recent low grade fevers, night sweats, and easy bruising/bleeding. Weight loss, lymphadenopathy, and hepatosplenomegaly on exam.

• Labs

  • CBC and immunophenotyping shows anemia, thrombocytopenia, and leukocytosis with > 20,000 WBCs, > 5,000 B lymphocytes, and > 500 neutrophils/mL

  • Obtain CMP, PT, PTT, INR, peripheral blood smear

  • If patient develops fever: Obtain urinalysis, urine culture, blood culture, and CXR

• Administer yearly influenza vaccine and pneumococcal vaccine every 5 years, avoid live vaccines

• Refer to hematology/oncology for bone marrow biopsy and further evaluation

• Counseling

  • Treatment may include a combination of chemotherapy, radiation, monoclonal antibodies, and/or stem cell transplant

  • Survival rate is > 80% at 5 years

Notes

• Epidemiology and diagnosis

  • 85% of cases occur in patients age 65 or older

  • Only 15% of patients present with constitutional symptoms

  • Splenomegaly is the most common presentation (75% of patients)

  • Half of all diagnoses are made incidentally based on bloodwork

• Treatment

  • Asymptomatic patients with no anemia and fewer than 3 involved lymph nodes may be monitored without treatment

  • Patients with fever and <500 neutrophils per microliter should be started on antibiotics and admitted for further evaluation