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Chronic Lymphocytic Leukaemia (CLL)

Most common adult leukaemia — indolent, now managed with targeted therapies.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Hematoloji department. Book Appointment →

What is Chronic Lymphocytic Leukaemia (CLL)?

Chronic lymphocytic leukaemia (CLL) is characterised by clonal proliferation of mature-appearing B lymphocytes in blood and bone marrow and is the most common adult leukaemia in the West. It typically presents in the sixth–seventh decade with about a 2:1 male predominance, and most cases are discovered incidentally on routine blood counts.

Biological heterogeneity largely drives clinical behaviour. IGHV-mutated disease has a favourable prognosis, while TP53 mutation/17p deletion, NOTCH1 mutation and unmutated IGHV carry an adverse prognosis. TP53 abnormalities predict resistance to chemoimmunotherapy, so a BTK inhibitor is the preferred first-line option.

In early-stage asymptomatic CLL, treatment does not improve survival and active surveillance (‘watch and wait’) is the standard. Therapy is started once treatment criteria are met (active disease: Rai stage III–IV, rapidly doubling lymphocyte count, symptomatic splenomegaly, autoimmune haemolytic anaemia/thrombocytopenia).

Symptoms

Often asymptomatic — lymphocytosis on routine blood tests
Fatigue and malaise
Susceptibility to recurrent infections (hypogammaglobulinaemia)
Lymphadenopathy
Splenomegaly and hepatomegaly
Constitutional symptoms: night sweats, fever, weight loss (active disease)
Autoimmune haemolytic anaemia or ITP

Risk Factors

Age (>60 years)
Male sex
Family history of CLL or lymphoma
Agent Orange and other chemical exposures (weak association)
Transformation from MGUS (rare)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Refer to haematology for lymphocytosis to rule out CLL
  • Recurrent pneumonia or suspected immunodeficiency
  • Symptomatic lymphadenopathy and splenomegaly
  • Evaluate autoimmune haemolytic anaemia for underlying CLL

Treatment Methods

01
Active surveillance (‘watch and wait’) until treatment criteria are met
02
BTK inhibitors: ibrutinib, acalabrutinib, zanubrutinib — effective first-line including TP53-altered disease
03
BCL-2 inhibitor: venetoclax with obinutuzumab — time-limited therapy option
04
Chemoimmunotherapy (FCR: fludarabine, cyclophosphamide, rituximab) in young IGHV-mutated patients
05
Rituximab/obinutuzumab: combined with targeted agents
06
Allogeneic stem cell transplant for high-risk or refractory disease
07
IVIg prophylaxis in hypogammaglobulinaemia

Which Department to Visit?

You can visit our Hematoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.