Chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma (SLL)

From greek.doctor

Chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma (SLL) are indolent, mature, non-Hodgkin B-cell neoplasms characterised by accumulation of functionally incompetent lymphocytes. Both CLL and SLL are the same disease with different manifestations. When the disease primarily affects the blood, it’s CLL. When it primarily affects the lymphatic tissue (lymph nodes), it’s SLL.

CLL is the most common adult leukaemia. It mostly affects elderly.

Clinical features

CLL/SLL is often asymptomatic, discovered incidentally on laboratory tests. Possible symptoms include:

  • B-symptoms (drenching night sweats, fever, weight loss)
  • Lymphadenopathy (may come and go)
  • Splenomegaly
  • Symptoms of cytopaenias

Diagnosis and evaluation

Labs show:

  • Prominent lymphocytosis
  • Mild neutropaenia
  • Mild anaemia
  • Mild thrombocytopaenia

Blood smear shows that the lymphocytes are small and mature, as well as smudge cells. Flow cytometry shows mature monoclonal B lymphocytes. If involvement of a lymph node is suspected, a biopsy should be performed of that lymph node. Following diagnosis, genetic testing is essential to select the most effective treatment options.

Treatment

Because it’s an indolent malignancy, CLL/SLL grows very slowly, and so treatment is often unnecessary or unlikely to improve survival. Asymptomatic early stage CLL/SLL is followed up for progression rather than treated.

Symptomatic or advanced stage CLL/SLL is managed with chemotherapy, as well as additional drugs depending on the genetic characteristics of the specific case. Options include ibrutinib, rituximab, venetoclax, etc.