Chronic lymphocytic leukaemia

Chronic lymphocytic leukaemia (CLL) is the commonest leukaemia in the Western world. It is a disease of the elderly and is usually incurable except in a minority of patients suitable for allogeneic haematopoietic stem cell transplantation.Many CLL patients are asymptomatic and the condition is diagnosed following the incidental finding of a sustained lymphocytosis. Clinical features arise as a result of immune dysfunction and tissue infiltration, and include malaise, recurrent infection, lymphadenopathy, hepatosplenomegaly and anaemia. Key diagnostic tests are peripheral blood morphology, assessed by a blood film, and immunophenotyping. Clinical staging, lymphocyte doubling time and biomarkers are useful in assessing prognosis. Overall the median survival is 10 years.Patients with CLL are regularly monitored and therapy is reserved for those with symptomatic or rapidly progressive disease. Earlier intervention has no impact on outcome and may encourage drug resistance. As CLL is a typically a disease of the elderly, particular consideration must be given to the patient's fitness for treatment and the management of co-morbidities.Supportive care includes measures to prevent and treat infection, transfusion support and the identification and therapy of autoimmune cytopenias. Chemotherapy remains the mainstay of treatment but more specific agents that target cell-signalling pathways are currently in development.