Many patients are asymptomatic at diagnosis, particularly patients with early stage disease. Symptoms may include weakness, malaise, fatigue, night sweats, and low-grade fever without evidence of infection. Unintentional weight loss is not common but if it reaches or exceeds 10% body weight in a 6-month period, it is an indication for treatment. Classical B symptoms are uncommon in patients with CLL, and if present in those with long-standing disease may indicate transformation to large-cell lymphoma (Richter transformation). Less commonly, patients may complain of rheumatology-type symptoms, such as arthralgias and myalgias. These rheumatologic symp-

Table 23.2 Benign lymphocytosis

Lymphocyte population


B Cell


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