• progressive accummulation of immunologically incompetent B cells
• more so in men than women
• most common leukemia in Western world
• median age: 62
• median survival of about 9 yrs
• advanced disease has increased morbidity and mortality often from opportunisitic infection
• acount for 30% of adult leukemias

• differ from normal B cells
  • express CD5
  • lack surface Ig's (hypogammaglobinemia)
• produce reduced amounts of normal Ig's in response to Ag stimuli

• signs
  • lymphadenopathy
  • hepatosplenomegaly
• variable presentation, asymptomatic, or nonspecific symptoms
  • recurrent infections in 10%
  • usually present for normal check up

• increase number of mature appearing lymphocytes
• anemia
• thrombocytopenia
• neutropenia
• bone marrow infiltrate lymph
• possible hypogammaglobinemia

• Rai staging
  • stage 0- lymphocytosis only (survive 12.5 yrs)
  • stage 1- lymphocytosis w/ lymphadenopathy (survive 8.4 yrs)
  • stage 2- splenomegaly (survive 6 yrs)
  • stage 3- anemia (survive 1.6 yrs)
  • stage 4- thrombocytopenia (SEE ABOVE)

We dont treat from lymphadenopathy and below if they are assymptomatic because this is incurable

• advanced stage at dx
• short lymphocyte doubling time
• diffuse pattern of marrow infiltration
• advanced age/males
• high serum levels of beta 2 microglobulin
• CLL-PLL
• abnormal karyotype

• 13q deletion (good prognosis)
• 11q deletion
• trisomy 12
• 17p deletion
• 6q deletion

All the others have bad prognosis