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CHRONIC LYMPHOCYTIC LEUKEMIA
(CLL)
CLL is a disorder of morphologically mature but
immunologically less mature lymphocytes and is
manifested by progressive accumulation of these
cells in the blood, bone marrow, and lymphatic
tissues. In this disorder, lymphocyte counts in the
blood are usually greater than or equal to
5,000/mm3 with a characteristic immunophenotype
(CD5- and CD23-positive B cells). As assays have
become more sensitive for detecting monoclonal
B-CLLlike cells in peripheral blood, researchers
have detected a monoclonal B-cell lymphocytosis
(MBL) in 3% of adults older than 40 years and 6%
in adults older than 60 years. Such early detection
and diagnosis may falsely suggest improved
survival for the group and may unnecessarily
worry or result in therapy for some patients who
would have remained undiagnosed in their lifetime,
a circumstance known in the literature as
overdiagnosis or pseudodisease.
In two selected series of more than 900 patients
followed prospectively for a median of 5 to 7
years, overt CLL requiring chemotherapy occurred
in 7% of patients. In a database analysis and for up
to 77 months before diagnosis, almost all patients
with a diagnosis of CLL had prediagnostic B-cell
clones that were identified in peripheral blood
when available.
For patients with progressing CLL, treatment with
conventional doses of chemotherapy is not
curative; selected patients treated with allogeneic
stem cell transplantation have achieved prolonged
disease-free survival. Antileukemic therapy is
frequently unnecessary in uncomplicated early
disease. The median survival for all patients ranges
from 8 to 12 years in older trials with data from the
1970s through the 1990s. There is, however, a
large variation in survival among individual
patients, ranging from several months to a normal
life expectancy. Treatment must be individualized
based on the clinical behavior of the disease.

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