Summary
Definition
History and exam
Key diagnostic factors
- shortness of breath and fatigue
- lymphadenopathy
- splenomegaly
- hepatomegaly
Other diagnostic factors
- presence of risk factors
- B symptoms
- recurrent infections
- epistaxis
- pallor
- petechiae
Diagnostic investigations
1st investigations to order
- FBC count with differential
- flow cytometry
- peripheral blood smear
Investigations to consider
- serum beta-2 microglobulin
- fluorescent in situ hybridisation (FISH)
- molecular genetic tests
- direct antiglobulin test (DAT)
- serum quantitative immunoglobulin
- lymph node biopsy
- bone marrow aspirate and trephine biopsy
- CT scan/fluorodeoxyglucose (FDG)-PET/CT
Treatment algorithm
Contributors
Authors
Jacqueline C. Barrientos, MD, MS
Associate Professor
Department of Medicine
Zucker School of Medicine at Hofstra/Northwell
CLL Research & Treatment Program
Northwell Health Cancer Institute
Lake Success
NY
Disclosures
JCB has been a consultant for Beigene, Abbvie, and AstraZeneca; received honoraria from Janssen; and received research funding from Oncternal, VelosBio, and Pharmacyclics.
Joanna M. Rhodes, MD, MSCE
Assistant Professor
Department of Medicine
Zucker School of Medicine at Hofstra/Northwell
CLL Research and Treatment Program
Northwell Health Cancer Institute
Lake Success
NY
Disclosures
JMR has received fees for consulting for Abbvie, Genentech, Pharmacyclics, Beigene, AstraZeneca, Morphosys, Epizyme, ADC Therapeutic, TG Therapeutics, Versatem, SeaGen, and Jannsen. JMR’s institution has received research support from Oncternal Pharmaceutics, Pharmacyclics, Acerta, Loxo Oncology, Velosbios, Abbvie, and AstraZeneca.
Acknowledgements
Dr Jacqueline C. Barrientos and Dr Joanna M. Rhodes would like to gratefully acknowledge Dr Vidhya Murthy, Dr Shankaranarayana Paneesha, and Dr Robert Chen, previous contributors to this topic.
Disclosures
VM has received a consultancy fee from Janssen, and a grant from Takeda for the ASH Annual Meeting 2014. SP has received consultancy and speaker fees from Janssen, Gilead, AbbVie, Bristol-Myers Squibb, and Takeda. RC declares that he has no competing interests.
Peer reviewers
Alessandra Ferrajoli, MD
Associate Medical Director, Professor
Department of Leukemia Center
The University of Texas MD Anderson Cancer Center
Houston
TX
Disclosures
AF declares that she has no competing interests.
Farrukh Awan, MD
Professor of Medicine
Department of Internal Medicine
UT Southwestern Medical Center
Dallas
TX
Disclosures
FA declares that he has no competing interests.
Paolo F. Caimi, MD
Associate Professor
Department of Medicine
Case Western Reserve University
Case Comprehensive Cancer Center
Cleveland
OH
Disclosures
PFC has received honoraria from Celgene for participation in a speaker bureau, and from Kite Pharma for participation in an advisory board.
Daniel Catovsky, MD, FRCP, FRCPath, DSc, FMedSc
Consultant Haemato-oncologist
Section of Haemato-Oncology
The Institute of Cancer Research
Sutton
UK
Disclosures
Unfortunately, we have since been made aware that DC is deceased.
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