Chronic Lymphocytic Leukemia (CLL)

Chronic Lymphocytic Leukemia (CLL):

  • Early-stage or asymptomatic CLL: Observation.
    • No proven advantage to early treatment if asymptomatic.
  • Indications for treatment:
    • Bulky lymphadenopathy or organomegaly
    • Constitutional symptoms (weakness, B symptoms)
    • Bone marrow failure (anemia or thrombocytopenia) for progressive CLL
    • Autoimmune hemolysis or autoimmune thrombocytopenia failing usual therapy
    • Rapidly progressive disease or Richter transformation
      • Richter syndrome: transformation to aggressive lymphoma
        • Occurs in 5% of patients and is difficult to treat
        • Suspect if rapid growth in one or more lymph nodes or worsening B symptoms
      • Active drugs:
        • Purine analogues: Fludarabine
        • Antibodies: Rituximab, Alemtuzumab (Campath; anti-CD52 antibody)
        • Alkylating agents: Chlorambucil (commonly used as a single agent), Cyclophosphamide
        • Other: Bendamustine
      • For hypogammaglobulinemia and frequent infections:
        • IV Ig

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