II. Epidemiology
- Chronic Leukemia is primarily an adult chronic cancer (esp. over age 65 years)
IV. Symptoms
- Asymptomatic at presentation (incidentally diagnosed based on CBC with Leukocytosis)
- Chronic Lymphocytic Leukemia
- Asymptomatic at diagnosis: 50%
- Chronic Myelogenous Leukemia
- Asymptomatic at diagnosis: 20%
- Chronic Lymphocytic Leukemia
- Symptomatic Patients
- Symptoms are much less common in Chronic Leukemia than with Acute Leukemia)
- Constitutional symptoms
V. Signs
- Splenomegaly (46 to 76% of CML cases)
- Hepatomegaly (CLL or CML)
- Lymphadenopathy (CLL or CML)
VI. Labs
-
Complete Blood Count (both CLL and CML)
- Leukocytosis (or Hyperleukocytosis)
- White Blood Cell Count is >20,000/mm3 in most cases, and often >100,000/mm3 (Hyperleukocytosis)
- Contrast with normal white cell counts or Leukopenia associated with Acute Leukemias
- Leukocytosis (or Hyperleukocytosis)
-
Chronic Lymphocytic Leukemia (CLL)
- Significant increase of normal appearing Lymphocytes (>50% of cells)
- Peripheral blood for clonal expansion of B Lymphocytes >5000/mm3, and confirmed by flow cytometry
- Bone Marrow Biopsy is not needed for diagnosis (but defines extent of marrow involvement related to prognosis)
-
Chronic Myelogenous Leukemia (CML)
- Peripheral Smear with few blast cells and increased Basophils and Eosinophils
- Philadelphia Chromosome (BCR-ABL1 Fusion Gene) on peripheral blood or Bone Marrow testing
- Present in 90 to 95% of CML cases
- Also present in ALL (2-4% of children, 20-40% of adults)