Chronic Lymphocytic leukemia (CLL):

Definition:Chronic neoplastic disorder characterized by accumulation of small

mature-looking lymphocytes which are immunologically immature in blood, bone marrow and lymph nodes.

• It is of either B- or T-cell type.

• Chronic persistent of lymphocytosis.

• Subtypes of CLL are distinguished by morphology, immunophenotyping and cytogenetics.

Chronic Leukemia

Dr. Rania Alhady 1

B-cell Chronic lymphocytic leukaemia (B-CLL):

Affects people between 60-80 years of age.

• The tumor cell appears to be a relatively mature B cell with weak surface expression of immunoglobulin (Ig)M.

• The cells accumulate in the blood, bone marrow, liver, spleen and lymph nodes.

• Tumor cells have long survival with impaired apoptosis.

Chronic Leukemia

Dr. Rania Alhady 2

Clinical features of B-cell CLL:

1- The disease occurs in older subjects (> 50 years old).

2- Most cases are diagnosed when a routine blood test is performed.

3- Enlargement of cervical, axillary or inguinal lymph nodes is the most frequent clinical sign (Generalized lymphadenopathy)

4- Features of anemia may be present.

5- Bruising or purpura may occur due to thrombocytopenia.

6- Splenomegaly and, less commonly, hepatomegaly.

7- Immunosuppression is a significant problem.

Bacterial infections followed by viral and fungal infections such as herpes zoster are also seen.

Chronic lymphoid leukemia

Dr. Rania Alhady 3

Clinical features of B-cell CLL

Chronic lymphoid leukemia

Dr. Rania Alhady 4

Cervical lymphadenopathy Herpes zoster infection

Laboratory findings of B-cell CLL1- Peripheral blood:

WBCs: Absolute lymphocytosis (↑↑↑ >100.000)

Morphology: - Small mature looking lymphocytes

- Dense chromatin

- Small rim of cytoplasm

RBCs: Normocytic normochromic anaemia is present in later stages.

Platelets: ↓ .

2- Bone marrow: shows lymphocytic replacement of normal marrow elements (> 40%)

3- L.N.: Diffuse infiltration by mature looking lymphocytes.

4- Immunophenotyping: cells express CD5 (+ve in 90% of cases)

Pan B markers +ve: CD19, CD20, CD22

5- Cytogenetics.

Chronic lymphoid leukemia

Dr. Rania Alhady 5

Blood film in B-cell CLL

Chronic lymphoid leukemia

Dr. Rania Alhady 6

Chronic Myeloid leukemia (CML):

Definition:It is a clonal disorder of a stem cell.

• Accounts for around 15% of leukemias and may occur at any age.

• The main feature is the presence of Philadelphia chromosome (Ph) which occurs due to t(9,22) translocation.

Chronic Myeloid Leukemia

Dr. Rania Alhady7

Chronic Myeloid Leukemia

Dr. Rania Alhady 8

Clinical features

CML most frequently affect people between the ages of 40 and 60 years. However, it may occur in children. Symptoms include:

1- Symptoms related to hyper-metabolism (e.g.weight loss, anorexia-poor appetite- or night sweats).

2- Splenomegaly.

3- Features of anemia may include pallor, dyspnoea and tachycardia.

4- Gout or renal impairment caused by elevated levels of uric acid may be a problem.

5- Rare symptoms include visual disturbances.

6- In up to 50% of cases the diagnosis is made incidentally from a routine blood count.

Lab findings in CML1- Peripheral blood:

WBCs: - ↑↑↑ >50.000

- The levels of neutrophils and myelocytes exceed those of blast cells and promyelocytes

- Increased circulating basophils.

RBCs: Normocytic normochromic anaemia.

Platelets: ↑↑

2- Bone marrow: Aspirate: Hypercellular with predominance of granulopoiesis

Biopsy: No fat spaces & ↑↑ reticulin

3- Cytogenetics: Ph chromosome

4- Serum uric acid is usually high.

Chronic Myeloid Leukemia

Dr. Rania Alhady 9

Chronic Myeloid Leukemia

Dr. Rania Alhady 10

CML: peripheral blood film showing various stages of granulopoiesis