Chronic lymphocytic leukemia
Background
- Most common leukemia in adults in developed world
- Typically occurs in adults >55 yo
- Usually indolent disease, slow progression over up to 10 years
Clinical Features
- Nonspecific systemic symptoms: fever, malaise, fatigue, weight loss
- Lymphadenopathy, hepatosplenomegaly
- Recurrent and/or opportunistic infections: pneumonia, herpes simplex, zoster
- Signs/symptoms of anemia
- Signs/symptoms of thrombocytopenia
Differential Diagnosis
Related to Local Tumor Effects
- Malignant airway obstruction
- Bone metastases and pathologic fractures
- Malignant spinal cord compression
- Malignant Pericardial Effusion and Tamponade
- Superior vena cava syndrome
Related to Biochemical Derangement
- Hypercalcemia of malignancy
- Hyponatremia due to SIADH
- Adrenal insufficiency
- Tumor lysis syndrome
- Carcinoid syndrome
Related to Hematologic Derangement
Related to Therapy
- Chemotherapy-induced nausea and vomiting
- Cytokine release syndrome
- Chemotherapeutic drug extravasation
- Differentiation syndrome (retinoic acid syndrome) in APML
- Stem cell transplant complications
- Catheter-related complications
- Tunnel infection
- Exit site infection
- CVC obstruction (intraluminal or catheter tip thrombosis)
- Catheter-related venous thrombosis
- Fracture of catheter lumen
- Oncologic therapy related adverse events
Leukocytosis
- Normally responding bone marrow
- Infection
- Inflammation: tissue necrosis, infarction, burns, arthritis
- Stress: overexertion, seizures, anxiety, anesthesia
- Drugs: corticosteroids, lithium, beta agonists
- Trauma: splenectomy
- Hemolytic anemia
- Leukemoid malignancy
- Abnormal bone marrow
- Acute leukemia
- Chronic leukemia
- Myeloproliferative disorders
Evaluation
- CBC, peripheral smear
- absolute B-lymphocyte count > 5000 cells/μL
- mature lymphocytes with a dense nucleus and a narrow cytoplasmic border on smear
- Evaluate for complications/oncologic emergencies
Management
- Treat complications: see Neutropenic fever, DIC, Tumor lysis syndrome, Leukostasis and hyperleukocytosis, Hyperviscosity syndrome, Thromboembolism, Anemia, Thrombocytopenia, Stem cell transplant complications
- Consider heme/onc consult if new diagnosis or unfamiliar complication
Disposition
- If incidental finding or only very mild symptoms, discharge with close outpatient follow up
- Admit if complication
See Also
External Links
References
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