CLL remains an incurable disease with current therapy apart from a few allografted patients but most patients with early stage, asymptomatic CLL die of other, unrelated causes. Infection is major cause of morbidity and mortality in symptomatic patients. Advanced stage patients eventually develop refractory disease and bone marrow failure. Terminally some refractory patients show prolymphocytic transformation.

A minority (<10%) develop high grade NHL (Richter's syndrome): median interval from diagnosis 24 months; associated with all stages; abrupt onset; chemoresistant; median survival 4 months. Second malignancy (skin, colon) occurs in up to 20%.

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