Canterbury DHB

Context

Investigations for the New Patient With CLL

Asymptomatic, elderly patients with early stage, uncomplicated CLL do not require extensive investigation beyond confirmation of the diagnosis by CBC, film, and immunophenotyping. A younger patient who may be eligible for an allograft will need detailed work up. The following is a guide and further investigations should be directed by the clinical presentation:

History, physical examination, performance status

 

All patients

CBC, differential and film

3 x 5 EDTA (mauve top). 1 x 5 mL citrate, 1 x 5 mL plain.

All patients

Immunophenotyping of peripheral blood lymphocytes

2 x 5 mL EDTA (mauve top), send to surface markers lab (ext: 80917)

All patients

ONCO profile, SPE, Ig levels

1 x 5 mL heparin, 1 x 5 mL plain

All patients

Direct antiglobulin test

1 x 7.5 mL EDTA (pink top)

All patients

Hepatitis B and C

 

All patients undergoing intensive therapy, e.g. FCR

HLA Typing

Contact SCT Coordinator. 4 x 10 mL CPDA, 1 x 10 mL plain, 1 x 5 mL EDTA.

Transplant-eligible patients only

Chromosome analysis and FISH
DNA samples

20 mL in heparin

Screen for TP53 in patients receiving intensive therapy

Bone marrow aspirate and trephine

Arrange with Haematology registrar

Not routinely required for diagnosis (see above) but may be desirable pre-treatment

Chest X-Ray

 

If clinically indicated

CT chest/abdomen/pelvis

 

Consider pre- and post-treatment CT in patients receiving intensive therapy

Lymph node biopsy

 

Consider in patients with bulky or progressive lymphadenopathy, high LDH, and/or extranodal lesions to exclude Richter’s transformation

Note: Additional tests may be required if a patient is enlisted into a CLL trial. Consult with trial document.

See Oscier, D., C. Dearden, et al. (2012). "Guidelines on the diagnosis, investigation and management of chronic lymphocytic leukaemia." Br J Haematol 159(5): 541-564.

In This Section

Monoclonal B-cell lymphocytosis

Monoclonal B-cell lymphocytosis

In the absence of lymphadenopathy or organomegaly (defined by physical examination or CT scan), cytopenias or B symptoms the presence of <5 x 109/l clonal B-cells with the immunophenotype of CLL (weak CD5+, CD19+, weak CD20+, CD23+, weak Ig+) is defined as Monoclonal B-cell lymphocytosis (MBL).

It is not uncommon to find a bone marrow infiltrate, median 20% lymphocytes, in patients with MBL. The percentage involvement has not been linked to the risk of progression to CLL. In the absence of other criteria for CLL, the finding of BM infiltration does not change the diagnosis from MBL to CLL or SLL.

MBL is a newly described entity that should not be considered a clinical disease. MBL carries a different risk of progression to CLL depending on the number of lymphocytes.

Further reading

Strati, P. and T. D. Shanafelt (2015). "Monoclonal B-cell lymphocytosis and early-stage chronic lymphocytic leukemia: diagnosis, natural history, and risk stratification." Blood 126(4): 454-462.

About this Canterbury DHB document (5509):

Document Owner:

Andrew Butler (see Who's Who)

Issue Date:

September 2018

Next Review:

September 2021

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 5509