Evaluation Of Patients With

Initial evaluation (Table 23.4) of patients suspected of having CLL should begin with a complete history and physical examination. There are no known associations between CLL and environmental exposures; therefore, exposure history is usually noncontributory. There is a strong association between genetics and risk for CLL,35-37 making family history an important part of the evaluation. Physical examination should concentrate on evaluation for adenopathy and hepatosplenomegaly. CBC with differential and morphologic examination of the blood smear provides both diagnostic and staging information. Immunophenotype analysis of blood or bone marrow is also required. Phenotypic markers for a complete workup should include Ig light chains (k and X), CD5, CD19, CD23, CD20, CD79b, FMC7, CD11c, CD22, CD25, CD10, and CD38 (prognostic). Karyotype analysis by FISH for 13q deletion, 17p deletion, 11q deletion, and trisomy 12 yields useful prognostic information for counseling patients; standard metaphase kary-otype is of lower yield and will often miss 13q deletion. Serum chemistries should be performed, including serum creatinine, especially if it is likely that treatment will be initiated. Measure of serum p-2-microglobulin

Table 23.3 Staging systems for CLL

Staging system

Simplified three-stage system

Clinical features at diagnosis

Estimated median survival (years)

Rai stage 0

0 0

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