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Blood film in CLL: numerous 'mature' lymphocytes with smear cells. From Oxford Textbook of Oncology, 2E, with permission.

Immunophenotyping: crucial to differentiation from other lymphocytoses (Qtoble p174). First line panel: CD2; CD5; CD19; CD23; FMC7; SmIg (k/l); CD22 or CD79b. CLL characteristically CD2 and FMC7 -ve; CD5, CD19 and CD23 +ve; SmIg, CD22, CD79b weak; k or l light chain restricted.

Immunoglobulins: immuneparesis (hypogammaglobulinaemia) common; monoclonal paraprotein (usually IgM) <5%. 169

Bone marrow: >30% 'mature' lymphocytes.

Trephine biopsy: provides prognostic information: infiltration may be nodular (favourable); interstitial; mixed; diffuse (unfavourable).

Lymph node biopsy: rarely required; appearances of lymphocytic lymphoma.

Cytogenetics: prognostic value; abnormalities in >80% using FISH: 13q-(55%), 11q- (18%), 12q+ (16%), 17p- (7%), 6q- (7%); 11q-, 17q- very unfavourable; sole 13q- or 6q- favourable. Clonal evolution occurs over time. 11q- and 17q- associated with advanced disease.

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