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Abbreviations: CLL, chronic lymphocytic leukemia; PLL, prolymphocyte leukemia; HCL, hairy cell leukemia; SLVL (SMZL), splenic lymphoma with villous lymphocytes.

common complaint that leads to medical attention is fatigue or malaise. Less often, enlarged lymph nodes or the development of an infection is the initial complaint. Bacterial infections, often pneumonia, are common. Occasionally, infections secondary to opportunistic organisms or herpes zoster virus develop. An exaggerated reaction to insect bites is also common. Weight loss is noted by some patients, but is rarely severe. In contrast to lymphomas and Hodgkin's disease, fever in the absence of infection is rare in CLL. The lymph nodes, when enlarged, are usually discrete, freely movable, and nontender. Painful enlarged nodes usually indicate a superimposed infection or Richter's transformation. Enlargement of the cervical nodes occurs more commonly than axillary or inguinal adenopathy. Hepatomegaly may be noted at the time of diagnosis in about 20 percent of patients. Skin involvement occurs in less than 5 percent of cases. In contrast to lymphomas, gastrointestinal involvement is rare, as is leptomeningeal leukemia.

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