Diagnosing CLL

• The International Workshop on CLL (IWCLL) 2008 update⁹ of the National Cancer Institute–sponsored Working Group (NCI-WG) has outlined specific criteria for diagnosing and initiating treatment of CLL^9,12 (Table 1)
• The updated guidelines have added consideration for patients who have an increase in clonal B lymphocytes but have less than the 5×10⁹/L that characterizes CLL⁹
  • In the absence of disease symptoms, including cytopenias, lymphadenopathy, and organomegaly, this patient population is determined to have monoclonal B-lymphocytosis (MBL). MBL may progress to CLL at a rate of 1% to 2% per year⁹
• The phenotype of CLL cells, characterized by the presence of several B-cell markers, such as CD19, CD20, and CD23, along with CD5, an antigen normally found on T cells, distinguishes it from other B-cell malignancies and is used for initial diagnosis^2,9,13,14
• Advances in flow cytometry have enabled immunophenotying to become a routine diagnostic tool used to differentiate CLL from such diseases as mantle cell and marginal zone lymphomas that may resemble CLL^1,9,15

Table 1. IWCLL update of the NCI-WG guidelines.^9,12

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