clinical features

Last reviewed 01/2018

CLL usually has an insidious onset. Approximately 70 - 80% of patients are diagnosed incidentally when they are found to have lymphocytosis (1).

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 (2).

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


  • 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) (2)