Clinical features

CLL usually has an insidious onset. Approximately 70 - 80% of patients are diagnosed incidentally when they are found to have lymphocytosis.

Rapidly progressive CLL occurs occasionally and is characterised by larger, less mature - appearing lymphocytes - "prolymphocytic" leukaemia.

When patients present with symptoms, the disease tends to have developed into a more advanced stage.

Typical clinical features of CLL include:

• non-specific symptoms -
  • “B” symptoms (lethargy, weight loss, fever and night sweats) and infections
  • of anaemia and thrombocytopenia - which may be autoimmune.
• lymphadenopathy
  • occurs in 80% of cases.
  • typically, moderate enlargement, affecting nodes in the neck, axilla and groin.
  • classically, symmetrical with non-tender, rubbery nodes
  • may have developed over a period of months or years.
• splenomegaly
  • in 50% of cases.
• heaptomegaly
• skin lesions - pruritus, Herpes zoster, generalised infiltration (l'homme rouge, usually associated with pruritus), vesibullous lesions

Note:

• B symptoms are not common but if present it might indicate that CLL has transformed into an aggressive large B-cell lymphoma (Richter’s transformation)

Reference:

1. Walewska R, Parry-Jones N, Eyre TA, et al. Guideline for the treatment of chronic lymphocytic leukaemia. Br J Haematol. 2022 Jun;197(5):544-57.