This week's artwork was donated by Gavin, a pediatric cancer patient who received treatment at The Children's Hospital of Philadelphia . Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. Lymphocyte counts in the blood are usually equal to or higher than 10,000 per cubic millimeter.
Antileukemic therapy is frequently unnecessary in uncomplicated early disease.
The clinical course of this disease progresses from an indolent lymphocytosis without other evident disease to one of generalized lymphatic enlargement with concomitant pancytopenia. Complications of pancytopenia, including hemorrhage and infection, represent a major cause of death in these patients. Patients with CLL who show prolymphocytoid transformation maintain the classic CLL phenotype and have a worse prognosis than PLL patients. These patients often have neutropenia and a history of rheumatoid arthritis. The natural history is indolent, often marked by anemia and splenomegaly.