Chronic lymphocytic leukemia differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]

Overview

Differenting Chronic lymphocytic leukemia from other Diseases

Differentials based on Biomarkers


Differential Diagnosis Surface Immunoglobulin CD5 CD22/FMC7 CD23 CD79b CD103

Chronic lymphocytic leukemia

Weakly positive

Positive

Negative

Positive

Negative

Positive/Negative

Prolymphocytic leukemia

Strongly positive

Negative

Positive

Negative

Positive

Negative

Hairy cell leukemia

Strongly positive

Negative

Positive

Negative

Positive/Negative

Positive

Mantle cell lymphoma

Positive

Positive

Strongly positive

Negative

Strongly positive

Negative

Follicular lymphoma

Strongly positive

Negative

Positive

Negative

Strongly positive

Negative


  • Chronic lymphocytic leukemia must also be differentiated from other causes of fever, hepatosplenomegaly, and lymph node swelling such as:[2]

=Other Differentials

The following table differentiates chronic lymphocytic leukemia from other leukemias that may present with similar clinical features such as fever, fatigue, weight loss, recurrent infections and elevated leukocyte counts. The following are the differentials:

Characteristic Causes Laboratory abnormalities Physical examination Therapy Other associations
Acute myeloid leukemia
  • Variable prognosis based on cytogenetic and molecular profile
  • Five new FDA-approved therapies became available in 2017-2018
Acute promyelocytic leukemia
Acute lymphoblastic leukemia
Chronic myeloid leukemia
Chronic lymphocytic leukemia[8]
  • Elevated absolute lymphocyte count (in all stages)
  • Presence of >5000 clonal B cells per microliter in peripheral blood
  • Anemia (in Rai stage III)
  • Thrombocytopenia (in Rai stage IV)
  • Fludarabine
  • Cyclophosphamide
  • Rituximab
  • Obinutuzumab[9]
  • Ofatumumab
  • Ibrutinib
  • Venetoclax

References

  1. 1.0 1.1 Hoffbrand V, Moss P. Essential Haematology. John Wiley & Sons; 2011
  2. Chronic Lymphocytic Leukimea. Wikipedia (2015) https://en.wikipedia.org/wiki/B-cell_chronic_lymphocytic_leukemia Accessed on October ,12 2015
  3. Döhner H, Estey E, Grimwade D, Amadori S, Appelbaum FR, Büchner T; et al. (2017). "Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel". Blood. 129 (4): 424–447. doi:10.1182/blood-2016-08-733196. PMC 5291965. PMID 27895058.
  4. McClellan JS, Kohrt HE, Coutre S, Gotlib JR, Majeti R, Alizadeh AA; et al. (2012). "Treatment advances have not improved the early death rate in acute promyelocytic leukemia". Haematologica. 97 (1): 133–6. doi:10.3324/haematol.2011.046490. PMC 3248942. PMID 21993679.
  5. Terwilliger T, Abdul-Hay M (2017). "Acute lymphoblastic leukemia: a comprehensive review and 2017 update". Blood Cancer J. 7 (6): e577. doi:10.1038/bcj.2017.53. PMC 5520400. PMID 28665419.
  6. Inaba H, Greaves M, Mullighan CG (2013). "Acute lymphoblastic leukaemia". Lancet. 381 (9881): 1943–55. doi:10.1016/S0140-6736(12)62187-4. PMC 3816716. PMID 23523389.
  7. Chen Y, Li S (2014). "Omacetaxine mepesuccinate in the treatment of intractable chronic myeloid leukemia". Onco Targets Ther. 7: 177–86. doi:10.2147/OTT.S41786. PMC 3916637. PMID 24516334.
  8. Kipps TJ, Stevenson FK, Wu CJ, Croce CM, Packham G, Wierda WG; et al. (2017). "Chronic lymphocytic leukaemia". Nat Rev Dis Primers. 3: 16096. doi:10.1038/nrdp.2016.96. PMC 5336551. PMID 28102226.
  9. Al-Sawaf O, Fischer K, Engelke A, Pflug N, Hallek M, Goede V (2017). "Obinutuzumab in chronic lymphocytic leukemia: design, development and place in therapy". Drug Des Devel Ther. 11: 295–304. doi:10.2147/DDDT.S104869. PMC 5279834. PMID 28182141.


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