Highlights & Basics
- Chronic lymphocytic leukemia (CLL) is an indolent hematologic cancer that occurs with increasing age.
- Usually presents with absolute lymphocytosis as an incidental finding on routine complete blood count (CBC) or with asymptomatic lymphadenopathy.
- Diagnosed by CBC with differential, blood smear showing smudge cells, and flow cytometry.
- Variable clinical course with most patients experiencing very slow progressive disease.
- Clinical and laboratory criteria are used to determine treatment approach and prognosis.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018 Jun 21;131(25):2745-60.[Abstract][Full Text]
Eichhorst B, Robak T, Montserrat E, et al; ESMO Guidelines Committee. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021 Jan;32(1):23-33.[Abstract][Full Text]
Hallek M, Al-Sawaf O. Chronic lymphocytic leukemia: 2022 update on diagnostic and therapeutic procedures. Am J Hematol. 2021 Dec 1;96(12):1679-705.[Abstract][Full Text]
Walewska R, Parry-Jones N, Eyre TA, et al. Guideline for the treatment of chronic lymphocytic leukaemia. Br J Haematol. 2022 Jun;197(5):544-57.[Abstract][Full Text]
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma [internet publication].[Full Text]
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20. Hamblin TJ, Davis Z, Gardiner A, et al. Unmutated Ig V(H) genes are associated with a more aggressive form of chronic lymphocytic leukemia. Blood. 1999 Sep 15;94(6):1848-54.[Abstract][Full Text]
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24. Bulian P, Shanafelt TD, Fegan C, et al. CD49d is the strongest flow cytometry-based predictor of overall survival in chronic lymphocytic leukemia. J Clin Oncol. 2014 Mar 20;32(9):897-904.[Abstract][Full Text]
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29. Walewska R, Parry-Jones N, Eyre TA, et al. Guideline for the treatment of chronic lymphocytic leukaemia. Br J Haematol. 2022 Jun;197(5):544-57.[Abstract][Full Text]
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31. Rossi D, Rasi S, Spina V, et al. Integrated mutational and cytogenetic analysis identifies new prognostic subgroups in chronic lymphocytic leukemia. Blood. 2013 Feb 21;121(8):1403-12.[Abstract][Full Text]
32. Marionneaux SM, Keohane EM, Lamanna N, et al. Smudge cells in chronic lymphocytic leukemia: pathophysiology, laboratory considerations, and clinical significance. Lab Med. 2021 Sep 1;52(5):426-38.[Abstract][Full Text]
33. Nowakowski GS, Hoyer JD, Shanafelt TD, et al. Percentage of smudge cells on routine blood smear predicts survival in chronic lymphocytic leukemia. J Clin Oncol. 2009 Apr 10;27(11):1844-9.[Abstract][Full Text]
34. Rossi D, Gaidano G. The clinical implications of gene mutations in chronic lymphocytic leukaemia. Br J Cancer. 2016 Apr 12;114(8):849-54.[Abstract][Full Text]
35. Zent CS, Kay NE. Autoimmune complications in chronic lymphocytic leukaemia (CLL). Best Pract Res Clin Haematol. 2010 Mar;23(1):47-59.[Abstract][Full Text]
36. Autore F, Pasquale R, Innocenti I, et al. Autoimmune hemolytic anemia in chronic lymphocytic leukemia: a comprehensive review. Cancers (Basel). 2021 Nov 19;13(22):5804.[Abstract][Full Text]
37. Atallah-Yunes SA, Haddadin F, Kadado A, et al. A nationwide study for patterns of immune thrombocytopenia treatment in patients with chronic lymphocytic leukemia. Paper presented at: 2019 ASCO Annual Meeting I. Jun 1-3, 2019. Chicago, IL. Health services research, clinical informatics, and quality of care: abstract e18193. J Clin Oncol. 2019 May 20;37(15_Suppl):e18193.[Full Text]
38. Thompson PA, Tam CS, O'Brien SM, et al. Fludarabine, cyclophosphamide, and rituximab treatment achieves long-term disease-free survival in IGHV-mutated chronic lymphocytic leukemia. Blood. 2016 Jan 21;127(3):303-9.[Abstract][Full Text]
39. Rossi D, Terzi-di-Bergamo L, De Paoli L, et al. Molecular prediction of durable remission after first-line fludarabine-cyclophosphamide-rituximab in chronic lymphocytic leukemia. Blood. 2015 Oct 15;126(16):1921-4.[Abstract][Full Text]
40. Fischer K, Bahlo J, Fink AM, et al. Long-term remissions after FCR chemoimmunotherapy in previously untreated patients with CLL: updated results of the CLL8 trial. Blood. 2016 Jan 14;127(2):208-15.[Abstract][Full Text]
41. Binet JL, Auquier A, Dighiero G, et al. A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer. 1981 Jul 1;48(1):198-206.[Abstract]
42. International CLL-IPI Working Group. An international prognostic index for patients with chronic lymphocytic leukaemia (CLL-IPI): a meta-analysis of individual patient data. Lancet Oncol. 2016 Jun;17(6):779-90.[Abstract]
43. National Institute for Health and Care Excellence. Suspected cancer: recognition and referral. Aug 2023 [internet publication].[Full Text]
44. Burger JA. Treatment of chronic lymphocytic leukemia. N Engl J Med. 2020 Jul 30;383(5):460-73.[Abstract]
45. Eyre TA, Hori S, Munir T. Treatment strategies for a rapidly evolving landscape in chronic lymphocytic leukemia management. Hematol Oncol. 2022 Apr;40(2):129-59.[Abstract]
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47. Eichhorst B, Fink AM, Bahlo J, et al. First-line chemoimmunotherapy with bendamustine and rituximab versus fludarabine, cyclophosphamide, and rituximab in patients with advanced chronic lymphocytic leukaemia (CLL10): an international, open-label, randomised, phase 3, non-inferiority trial. Lancet Oncol. 2016 Jul;17(7):928-42.[Abstract]
48. Mato AR, Woyach JA, Brown JR, et al. Pirtobrutinib after a covalent BTK inhibitor in chronic lymphocytic leukemia. N Engl J Med. 2023 Jul 6;389(1):33-44.[Abstract]
49. Tang CPS, Lip GYH, McCormack T, et al. Management of cardiovascular complications of bruton tyrosine kinase inhibitors. Br J Haematol. 2022 Jan;196(1):70-8.[Abstract][Full Text]
50. Jain P, Thompson PA, Keating M, et al. Long-term outcomes for patients with chronic lymphocytic leukemia who discontinue ibrutinib. Cancer. 2017 Jun 15;123(12):2268-73.[Abstract][Full Text]
51. Leong DP, Caron F, Hillis C, et al. The risk of atrial fibrillation with ibrutinib use: a systematic review and meta-analysis. Blood. 2016 Jul 7;128(1):138-40.[Abstract][Full Text]
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53. Fischer K, Al-Sawaf O, Hallek M. Preventing and monitoring for tumor lysis syndrome and other toxicities of venetoclax during treatment of chronic lymphocytic leukemia. Hematology Am Soc Hematol Educ Program. 2020 Dec 4;2020(1):357-62.[Abstract][Full Text]
54. Gribben JG. Practical management of tumour lysis syndrome in venetoclax-treated patients with chronic lymphocytic leukaemia. Br J Haematol. 2020 Mar;188(6):844-51.[Abstract][Full Text]
55. Medicines and Healthcare products Regulatory Agency. Venetoclax (Venclyxto): updated recommendations on tumour lysis syndrome (TLS). Dec 2021 [internet publication].[Full Text]
56. US Food and Drug Administration. Drug safety communication: FDA warns about possible increased risk of death and serious side effects with cancer drug Copiktra (duvelisib). Jun 2022 [internet publication].[Full Text]
57. ClinicalTrials.gov. A phase 3 study of duvelisib versus ofatumumab in patients with relapsed or refractory CLL/SLL (DUO). NCT02004522. Jan 2022 [internet publication].[Full Text]
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63. Kharfan-Dabaja MA, Kumar A, Behera M, et al. Systematic review of high dose chemotherapy and autologous haematopoietic stem cell transplantation for chronic lymphocytic leukaemia: what is the published evidence? Br J Haematol. 2007 Oct;139(2):234-42.[Abstract][Full Text]
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65. Roeker LE, Dreger P, Brown JR, et al. Allogeneic stem cell transplantation for chronic lymphocytic leukemia in the era of novel agents. Blood Adv. 2020 Aug 25;4(16):3977-89.[Abstract][Full Text]
66. D'Souza A, Fretham C, Lee SJ, et al. Current use of and trends in hematopoietic cell transplantation in the United States. Biol Blood Marrow Transplant. 2020 Aug;26(8):e177-82.[Abstract][Full Text]
67. Fink AM, Bahlo J, Robrecht S, et al. Lenalidomide maintenance after first-line therapy for high-risk chronic lymphocytic leukaemia (CLLM1): final results from a randomised, double-blind, phase 3 study. Lancet Haematol. 2017 Oct;4(10):e475-86. [Abstract]
68. Chanan-Khan AA, Zaritskey A, Egyed M, et al. Lenalidomide maintenance therapy in previously treated chronic lymphocytic leukaemia (CONTINUUM): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Haematol. 2017 Nov;4(11):e534-43.[Abstract]
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70. National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) Program. SEER Explorer: chronic lymphocytic leukemia (CLL) SEER relative survival rates by time since diagnosis, 2000-2018. 2022 [internet publication].[Full Text]
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