Haematology  |  CLL Pathway - Signs, symptoms & staging


CLL Pathway - Signs, symptoms & staging


  • In the early stages, the condition is asymptomatic, the only feature being a peripheral lymphocytosis.
  • CLL usually progresses slowly with increasing lymphocytosis, lymphadenopathy, splenomegaly, hepatomegaly and bone marrow involvement with cytopenias. Systemic symptoms (fever, weight loss and night sweats) are rare.
  • Other complications of CLL include autoimmune haemolytic anaemia, immune thrombocytopenia and hypogammaglobulinaemia with recurrent infections and herpes zoster. CLL can also transform to high-grade lymphoma (Richter’s transformation).
  • Due to the increased risk of infections prompt antibiotic therapy should be offered.


  • The following are considered as one area of organ enlargement each: neck, axillae, groin, spleen, liver e.g. bilateral cervical nodes = one site
  • Lymphadenopathy in CLL is usually bilateral, soft, mobile and painless. Unilateral lymphadenopathy is unusual in CLL and may require further investigation.




Prognosis (median survival – years)


0-2 areas of organ enlargement

>12+ years


3-5 areas of organ enlargement

7 years


Hb <100 g/L or platelets <100x109/L

(unless due to immune mechanisms)

2 years


Last updated : Wednesday, September 05, 2018
Next review date : Thursday, September 05,2019

Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.