Chronic Lymphocytic Leukemia

Diagnosis

A hematologist evaluates and confirms the diagnosis of chronic lymphocytic leukemia (CLL) through a detailed medical interview, physical examination, special blood samples and general tests to assess internal organ function.

Tests to Confirm Diagnosis

A complete blood count is a measurement of the red blood cells, white blood cells and platelets.

Flow cytometry is a test in which blood cells are examined with antibodies to show if they are malignant or not.

Bone marrow biopsy may provide valuable information in some individuals at diagnosis. It may often be safely delayed until needed to help with treatment decisions.

Lymph node biopsy may also occasionally be used.

Tests for Prognostic (Predictive) Information

To predict how the leukemia will progress, special tests are done on the blood or bone marrow cells to look at characteristics of the leukemic cells. The tests used include:

• FISH (fluorescence in situ hybridization) is a test to determine the presence of chromosomal abnormalities in the CLL cells. Abnormalities of chromosome 13 (13q-) predicts for a less aggressive course, while abnormalities called 17p- and 11q- are associated with more progressive disease.
• Immunoglobulin gene mutation status, known as IgVH, can help predict a more aggressive course (if not mutated) and a more favorable course (if mutated). A technically complex test, it is available only through some academic institutions with active research laboratories.
• Higher levels of beta-2-microglobulin, ZAP 70 and CD38, if found in CLL patients, have been associated with more aggressive disease. These tests can help predict the time of progression for CLL from diagnosis to potential treatment.

Staging

Stage 0 is considered low risk. These patients have an elevated lymphocyte count only.

Stages I and II are considered intermediate risk. Stage I patients have an elevated lymphocyte count and enlarged lymph nodes. Stage II involves an elevated lymphocyte count and an enlarged spleen or liver.

Stages III and IV are considered higher risk classifications. Stage III patients have an elevated lymphocyte count and low red cell count (anemia). Stage IV patients have an elevated lymphocyte count and a low platelet count (thrombocytopenia).