The diagnosis of<unk>  may be suggested by abnormal results on a complete blood count (CBC), but additional testing is necessary to confirm the diagnosis. A CBC normally shows low counts for white blood cells, red blood cells, and platelets in<unk>  patients. However, if large numbers of<unk>  cells are in the blood stream, then normal or even high lymphocyte counts may be found. On physical examination, 80–90% of patients have an enlarged spleen, which can be massive. This is less likely among patients who are diagnosed at an early stage. Peripheral lymphadenopathy (enlarged lymph nodes) is uncommon (less than 5% of patients), but abdominal lymphadenopathy is a relatively common finding on computed tomography scans.<unk> : Abnormal B cells look<unk> " under a microscope because of radial projections from their surface. The most important laboratory finding is the presence of<unk>  cells in the bloodstream.<unk>  cells are abnormal white blood cells with<unk> like projections of cytoplasm; they can be seen by examining a blood smear or bone marrow biopsy specimen. The blood film examination is done by staining the blood cells with Wright's stain and looking at them under a microscope.<unk>  cells are visible in this test in about 85% of cases. Most patients require a bone-marrow biopsy for final diagnosis. The bone marrow biopsy is used both to confirm the presence of<unk>  and also the absence of any additional diseases, such as Splenic marginal zone lymphoma or B-cell prolymphocytic<unk> . The diagnosis can be confirmed by viewing the cells with a special stain known as TRAP (tartrate resistant acid phosphatase). More recently, DB44 testing assures more accurate results. Definitively diagnosing<unk>  is also possible through flow cytometry on blood or bone marrow. The<unk>  cells are larger than normal and positive for CD19, CD20, CD22, CD11c, CD25, CD103, and FMC7 antigens. (CD103, CD22, and CD11c are strongly expressed.)<unk> -variant <unk> -V), which shares some characteristics with B cell prolymphocytic<unk>  (B-PLL), does not show CD25 (also called the interleukin-2 receptor, alpha). The differential diagnoses include several kinds of anemia, including myelophthisis and aplastic anemia, and most kinds of blood neoplasms, including hypoplastic myelodysplastic syndrome, atypical chronic lymphocytic<unk> , B-cell prolymphocytic<unk> , or idiopathic myelofibrosis. Classification When not further specified, the "classic" form is often implied, but two variants have been described:<unk> -variant and a Japanese variant. The non-Japanese variant is more difficult to treat than either 'classic'<unk>  or the Japanese<unk> .<unk> -V<unk> -variant <unk> -V) is usually described as a prolymphocytic variant of<unk> . It was first formally described in 1980 by a paper from the University of Cambridge's Hayhoe laboratory. About 10% of people with<unk>  have this variant form of the disease, representing about 60-75 new cases of<unk> -V each year in the U.S. While classic<unk>  primarily affects men,<unk> -V is more evenly divided between males and females. While the disease can appear at any age, the median age at diagnosis is over 70. Similar to B-cell prolymphocytic<unk>  (B-PLL) in chronic lymphocytic<unk> ,<unk> -V is a more aggressive disease. Historically, it has been considered less likely to be treated successfully than is classic<unk> , and remissions have tended to be shorter. The introduction of combination therapy with concurrent rituximab and cladribine therapy, though, has shown excellent results in early follow-up. As of 2016, this therapy is considered the first-line treatment of choice for many people with<unk> -V. Many older treatment approaches, such as interferon-alpha, the combination chemotherapy regimen "CHOP", and common alkylating agents such as cyclophosphamide, showed very little benefit. Pentostatin and cladribine administered as monotherapy (without concurrent rituximab) provide some benefit to many people with<unk> -V, but typically induce shorter remission periods and lower response rates than when they are used in classic<unk> . More than half of people respond partially to splenectomy. In terms of B-cell development, the prolymphocytes are less developed than are lymphocytes or plasma cells, but are still more mature than their lymphoblastic precursors.<unk> -V differs from classic<unk>  principally in these respects: * Higher white blood cell counts, sometimes exceeding 100,000 cells per microliter * A more aggressive course of disease requiring more frequent treatment *<unk>  cells with an unusually large nucleolus for their size * Production of little excess fibronectin produced by classic<unk>  cells to interfere with bone marrow biopsies * Low or no cell-surface expression of CD25 (interleukin-2 IL-2 receptor alpha chain, or p55). Low levels of CD25, a part of the receptor for a key immunoregulating hormone, may explain why<unk> -V cases are generally much more resistant to treatment by immune-system hormones.<unk> -V, which usually features a high proportion of<unk>  cells without a functional p53 tumor suppressor gene, is somewhat more likely to transform into a higher-grade malignancy. A typical transformation rate of 5-6% has been postulated in the UK, similar to the Richter's transformation rate for SLVL and CLL. Among<unk> -V patients, the most aggressive cases normally have the least amount of p53 gene activity.<unk>  cells without the p53 gene tend, over time, to displace the less aggressive p53(+)<unk>  cells. Some evidence suggests that a rearrangement of the immunoglobulin gene VH4-34, which is found in about 40% of<unk> -V patients and 10% of classic<unk>  patients, may be a more important poor prognostic factor than variant status, with<unk> -V patients without the VH4-34 rearrangement responding about as well as classic<unk>  patients.<unk> -Japanese variant The variant called<unk> -Japanese variant, or<unk> -J, is more easily treated. Treatment with cladribine has been reported.
Hairy cell leukemia
Chronic lymphocytic leukemia
Prolymphocytic leukemia
B-cell leukemia
T-lymphoblastic leukemia/lymphoma
T-cell leukemia
Large granular lymphocytic leukemia
Leukemoid reaction