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Year : 2022  |  Volume : 5  |  Issue : 1  |  Page : 39-45

Chronic lymphocytic leukemia: Current approach to lab diagnosis

Department of Laboratory Medicine, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India

Correspondence Address:
Dr. Narender Tejwani
Department of Laboratory Medicine, Rajiv Gandhi Cancer Institute & Research Centre, Sir Chotu Ram Marg, Rohini Institutional Area, Sector 5, Rohini, New Delhi 110085
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jco.jco_12_22

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Chronic lymphocytic leukemia (CLL) is the most common type of clinically encountered chronic lymphoproliferative disorder (CLPD). The disease was first found in 19th century and was described as asymptomatic leukemia which peacefully coexists with the host. The disease has an indolent clinical course and often picked up when complete blood count is done for an unrelated medical indication. CLL is a disease of elderly and the incidence increases as the age increases. However, Indian patient present early as compared to USA and Europe. There is a slight male preponderance reported worldwide. CLL is often preceded by a non-clinical phase called monoclonal B cell lymphocytosis (MBL) to which is closely related both immunophenotypically and spectrum of molecular aberrations. Recently describe low count MBL however appears to be a distinctive disease of unknown significance as there is not sufficient data to prove that they pose a higher risk of progression to MBL/CLL. Their genetic profile also is very different from MBL/CLL. The symptomatic cases may present with symptoms related to disease progression like cytopenias due to hematopoietic cells replacement or lymph node enlargement or liver/spleen enlargement. The symptoms may also be related to secondary autoimmune phenomena like autoimmune hemolytic anemia and autoimmune thrombocytopenia. The disease diagnoses mostly rely on the use of multi-parametric flowcytometry and peripheral blood morphology. The peripheral smear shows the presence of small cell lymphocytosis with numerous smudge cells. The flowcytometric immunophenotyping show loss of Pan-B cell markers like surface immunoglobulin, CD79b, CD22, and FMC-7. The expression of these markers is either negative or dimmer when compared to normal mature B cells. CD20 expression is also dim as compared to normal mature B cells. Along with the loss of Pan-B cell markers, there is a gain of CD5 (A T cell markers) and CD23. CD200 has emerged as a very useful marker to differentiate this neoplasm from Mantle cell lymphoma which characteristically is CD5 positive, does not show loss of Pan-B cell markers and is negative or Dim positive for CD200. The other differential diagnosis remains other causes of small cell CLPDs like hairy cells, marginal zone lymphomas, lympho-plasmacytic lymphoma, and follicular lymphomas. These cases can be easily differentiated when morphology is combined with flow cytometric findings. In difficult cases, one can use Matutes score where a score of 4 or 5 will indicate a diagnosis of CLL.

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