Q: My mother underwent a bone marrow test. All the reports are not available as yet. She has been diagnosed with Lymphoproliferative disorder. The report states as follows - normocytic red cells, TLC increase with relative lymphocytosis with smudge cells seen. No increase in prolymphocytes seen. Platelets adequate, bone marrow aspirate cellular M-E ration 3:1. Mature lymphocytes form 50% of all nucleated cells. Erythropoeisis is normoblastic. Myelopoeisis is normal. Occasional megakaryocytes seen. What does this mean?

A:Your mother is likely suffering from chronic lymphocytic leukaemia (CLL), a malignant haematologic disorder characterised by a progressive accumulation of functionally incompetent mature lymphocytes. It is a disease of the elderly individuals primarily affecting individuals older than 55 years. Immunophenotyping should be done to exactly delineate the disorder as several diseases mimic it. The disease is initially relatively benign but is later followed by a terminal progressive and resistant phase lasting 1-2 years during which the patient may be quite ill. It is divided into different clinical stages, which help decide the severity of illness and treatment required. Most patients at the time of diagnosis do not require any treatment unless they have weight loss of more than 10%, extreme fatigue, fever related to leukaemia, night sweats, progressive marrow failure, autoimmune anaemia or thrombocytopaenia not responding to prednisone, progressive splenomegaly, massive lymphadenopathy, or progressive lymphocytosis (an increase of greater than 50% in 2 months or a doubling time of less than 6 months). Patients at stage 0 whose disease is stable require only periodic follow-up as early treatment has not been demonstrated to be advantageous. CLL patients are immune incompetent and this is characterised by a progressive fall in the levels of gammaglobulins predisposing them to infections. Patients showing frequent bacterial infections are likely to benefit from monthly infusions of intravenous immunoglobulins.