A 60-year-old man is referred because of splenomegaly and generalized lymphadenopathy. The total white blood cell count is markedly elevated, and the differential count reveals a preponderance of mature-appearing lymphocytes. Bone marrow examination reveals a diffuse infiltration with similar-appearing lymphocytes. Which of the following statements best characterizes this disorder?
A. A progressive increase in the number of myeloblasts and promyelocytes is indicative of acceleration of the disease process.
B. Bacterial infections are common early in the disease due to hypogammaglobulinemia.
C. Mean survival is less than 1 year after diagnosis.
D. Myelofibrosis is a common complication.
E. The neoplastic lymphoid cells are most often T cells, not B cells.
The answer is B. The diagnosis is CLL. Hypogammaglobulinemia may occur early in the course of the disease, leading to frequent bacterial infections. The mean survival is 3 to 7 years after diagnosis, although much longer symptom-free survivals are quite common. CLL is characterized by a proliferation of neoplastic mature lymphoid cells, which are almost always B cells.
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