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CLL — RACP Adult Medicine MCQ

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EasyHaematologyCLLRACP Adult Medicine

A 70-year-old man presents with lymphocytosis (WCC 85 × 10⁹/L, lymphocytes 78 × 10⁹/L), hepatosplenomegaly, and bilateral cervical lymphadenopathy. Blood film shows small mature lymphocytes with smear cells (smudge cells). Flow cytometry shows CD5+, CD19+, CD23+, CD20dim. What is the most likely diagnosis?

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Correct answer: A — Chronic lymphocytic leukaemia

Marked lymphocytosis with small mature lymphocytes, smear cells, hepatosplenomegaly, lymphadenopathy, and characteristic immunophenotype (CD5+, CD19+, CD23+, CD20dim) is CLL. CLL is the most common leukaemia in adults in Western countries. Staging: Rai (US) or Binet (European). Treatment: observe if asymptomatic (watch and wait). Treat when iwCLL criteria are met (cytopenias, progressive lymphadenopathy/splenomegaly, B symptoms, doubling time <6 months).

Reference: ALLG – 2024 – CLL; iwCLL 2024; NCCN 2025