comprehensive case study of Chronic Lymphocytic Leukemia (CLL), a common type of leukemia characterized by the proliferation of abnormal lymphocytes. Explore the patient's clinical presentation, diagnostic workup, treatment options, and disease progression. Gain valuable insights into the challenges and complexities of managing CLL, including monitoring strategies, treatment decision-making, and supportive care interventions.

1. Patient with Chronic Lymphocytic Leukemia
By Sunidhi Singh
IM 434

2. Chronic Lymphocytic Leukemia
• results from an acquired injury of the DNA of a single
cell/lymphocyte in the bone marrow.
• this injury is not present at birth.
• it is a nonclonal disorder characterised by progressive
accumulation of functionally incompetent lymphocytes.

3. Case
• A 54-year old Black African man initially presented with
several complaints of painful and recurrent swellings on
the groin, armpit and neck. The patient also complained of
shiver, asthenia, fever, anorexia, headaches, pelvic pain,
lumbago, cough, sexual asthenia, and difficulty in
micturition. He was not on any regular medication and
had no history of exposure to toxic chemicals or ionizing
radiation. Physical examination was remarkable and
revealed cervical and axillary lymphadenopathy and
hepato-splenomegaly.

4. • Syndromes and Differential
• Syndromes:
• Pain syndrome
• Intoxication
• Asthenic syndrome
• Lymhpadenopathy
• Differential:
• other kinds of leukemia

5. Diagnosis
• Physical Exam and History:
• Swelling on groin, armpit and neck
• Fever, shivers
• anorexia
• Headache, pelvic pain
• Difficulty urinating
• hepatosplenomegaly, cervical and axillary
lymphadenopathy

6. Diagnosis:
• Laboratory Exams:
• Complete Blood Count:
• Leucocytosis
• Lymphocytosis
• Monocytosis
• Anemia
• Low Hemoglobin
• Thrombocytopenia
• Decreased MCV, MCh and MCHC

7. • Peripheral blood smear:
• 5% monocytes, 15%
neutrophils and 80%
lymphocytes.

8. • The leukaemia cells found in the blood smear are
charac_x0002_teristically small, mature-appearing
lymphocytes with a
• narrow border of cytoplasm and a dense nucleus
lacking
• discernible nucleoli and having partially
aggregated chro_x0002_matin. Larger, atypical
lymphocytes or prolymphocytes
• may be seen but must not exceed 55%.

9. • Flow Cytometry:
• circulating clonal B
lymphocytes expressing
CD5 CD19, CD20
• Additional tests:
• CT of chest, abdomen and
pelvis to rule out lesions.
• Bone marrow biopsy: is
not required.
• Staging:
• staging is determined on
the basis of Rai Sawitsky
system.

10. • Clinical Diagnosis:
• CLL is confirmed based on the evidences provided by
flow cytometry and perpheral blood smear findings.
• Stage:
• Stage III according to Rai Swatsky system.
• Survival of 30 months.

11. Treatment:
• Front line therapy:
• BTK inhibitor (BTKi) ±
• anti-CD20 monoclonal
• antibody (mAb)
• (Continuous treatment)
• Venetoclax + anti-CD20
• mAb
• (Fixed duration treatment)

12. • Second and third line therapies:
• monoclonal antibody therapy might be recommended.
• Chemotherapy is recommended
• Stem cell transplant is a treatment option for younger
patients, however it isnt recommended for this particular
case.

13. • Prognosis:
• the outcome is unfavourable.
• survival of upto 30 months is suggested.

14. finish
Thank You