Two Onc Docs
Chronic Lymphocytic Leukemia (CLL) 2025 UPDATE
Mar 31, 2025
Delve into the complexities of Chronic Lymphocytic Leukemia with updates on personalized treatment strategies and the latest therapies like CAR-T and non-covalent BTK inhibitors. Unpack the diagnostic criteria, staging systems, and essential prognostic factors, including immunoglobulin mutations. Discover the balance between treatment and observation for improved outcomes, while also addressing treatment toxicities and cardiovascular risks. Gain insights into managing initial and refractory disease, ensuring effective patient care.
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Quick takeaways
- CLL is primarily diagnosed in asymptomatic elderly patients presenting with lymphocytosis, requiring careful differentiation from similar disorders like mantle cell lymphoma.
- The choice of treatment for CLL is contingent on prognostic factors, with first-line therapies including BTK inhibitors for low-risk patients and more aggressive combination therapies for high-risk cases.
Deep dives
Diagnosis and Classification of CLL
Chronic lymphocytic leukemia (CLL) is often diagnosed in elderly asymptomatic patients who present with lymphocytosis, defined as more than 5,000 lymphocytes per microliter. Key diagnostic features include flow cytometry showing positivity for CD19 and CD5, along with dim expression of CD20 and positivity for CD23. It is important to differentiate CLL from similar disorders like mantle cell lymphoma, which presents with different immunophenotypic characteristics. The initial classification of CLL is crucial, as patients with an absolute lymphocyte count of less than 5,000 and no symptoms are categorized as having monoclonal B-cell lymphocytosis, which typically requires no further intervention.
