Onkológia 6/2014

Role of pathologist in the management of chronic lymphocytic leukaemia

In contrast to other malignant lymphomas and lymphoid leukaemias, biopsy examination is not required for making diagnosis and staging in typical cases of chronic lymphocytic leukaemia (CLL), in which diagnosis is usually made through examination of the peripheral blood or bone marrow (BM). This sometimes makes an impression that the role of pathologist in the management of CLL is only marginal and realized biopsy examinations are unreasonable. But making diagnosis and staging are not the only indications for biopsy examination. This article reviews indications for biopsy examination in CLL according to actual clinical guidelines and data from our practice. BM or lymph node (LN) biopsy may be helpful in cases with atypical cytomorphology, phenotype or when their findings are not conclusive. In the pretreatment period the BM biopsy is warranted to clarify the reason for unclear cytopenias or in clinical trials prior to initiating therapy with myelosuppressive agents. In the post-treatment period the BM biopsy is used for assessment of response, commonly not only for patients in clinical trials, but also in general practice. LN and BM biopsies are required to confirm the diagnosis of blastic transformation of CLL into an aggressive lymphoma.

Keywords: chronic lymphocytic leukemia, biopsy diagnostics, histomorphology.