The typical CLL cell represents an accumulation of clonal, mostly small, mature lymphocytes that exhibit a distinctive immunophenotype, circulate, and home in on lymphoid organs and bone marrow. Circulating cells have little capacity to proliferate, whereas small islands of dividing cells are usually present in lymph nodes, accounting for the slow cell production that is characteristic of this neoplasia. Putative genetic as well as soluble and other cellular factors may contribute to the remarkable resistance of these neoplastic cells to apoptosis. Although generally phenotypically uniform, kinetically quiescent, and resilient, CLL cells sometimes manifest biological variability, a feature that may be useful in predicting disease progression and therapy response.
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