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Chronic lymphocytic leukaemia/small lymphocytic lymphoma B015

Document
Last amended 
4 April 2016

Current RMA Instruments:

Consolidated  RH SOP
84 of 2014 as amended by 38 of 2016
Balance of Probabilities SOP
85 of 2014
Changes from previous Instruments:

SOP Bulletin 188

ICD Coding:
  • ICD-9-CM Codes: 204.1, 202.4, 204.8, 200.8, 200.80-200.88
  • ICD-10-AM Codes: C85.9, C91.1, C91.3, C91.4
Brief description

This is a haematological malignancy of B lymphocytes that can manifest in two different ways. When the disease occurs mostly in the blood stream and bone marrow it is called chronic lymphocytic leukaemia (CLL). When it occurs mostly in the lymph nodes or lymphoid tissue it is called small lymphocytic lymphoma (SLL).

Confirming the diagnosis

This diagnosis is complex and requires specialist opinion based on blood and bone marrow cytology or lymphoid tissue or lymph node histology.

The relevant medical specialist is a haematologist or haematologist oncologist.

Additional diagnoses covered by SOP
  • B cell prolymphocytic leukaemia
  • B-cell chronic lymphocytic leukaemia/small lymphocytic lymphoma
  • Chronic lymphatic / lymphoid leukaemia
  • Hairy cell leukaemia
Conditions not covered by SOP
  • Acute lymphoblastic leukaemia*
  • Acute myeloid leukaemia*
  • Adult T cell lymphoma/leukaemia* - non-Hodgkin's lymphoma
  • Chronic myeloid leukaemia*
  • Non-Hodgkin’s lymphoma* apart from small lymphocytic lymphoma
  • T cell prolymphocytic leukaemia#

* another SOP applies

# non-SOP condition

Clinical onset

CLL is generally asymptomatic and uncovered by routine blood testing.  SLL may present with a lump (enlarged lymph node), which is then biopsied. Clinical onset will generally be at the time of such testing or when the enlarged lymph node was first discovered.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  The condition is generally regarded as incurable, but typically progresses only slowly, with patients surviving for many years or even decades.  The initial management of early stage disease is often simply watchful waiting.  Inability to obtain appropriate treatment in that circumstance would not result in a clinical worsening.

Unconfirmed diagnosis

If, after applying the above information, you are unable to confirm the diagnosis, you should then seek medical officer advice about further investigation.

Haematological malignancy SOP classifications:

NameIncluded in SOPExcluded from SOP

Acute Lymphoblastic Leukaemia

(B or T cells)

  • (ICD-10 C91.0)
 
  • Burkitt’s leukaemia/lymphoma
  • Adult T-cell leukaemia/lymphoma
Acute Myeloid Leukaemia
  • Acute promyelocytic leukaemia
  • Acute myelomonocytic leukaemia
  • Acute monoblastic leukaemia
  • Actue moncytic leukaemia
  • Acute erthyroid leukaemia
  • Acute megakaryoblastic leukaemia
  • Acute basophilic leukaemia
  • Acute panmyelosis with myelofibrosis
  • Myeloid sarcoma
 

Chronic Lymphocytic Leukaemia/

Small Lymphocytic Lymphoma

(B cells)

  • Hairy cell leukaemia
  • B cell prolymphocytic leukaemia
  • Adult T cell lymphoma/leukaemia
  • T cell prolymphocytic leukaemia
  • Non-Hodgkin’s lymphoma other than small lymphocytic lymphoma.
  • Other B cell lymphoproliferative disorders

Chronic Myeloid Leukaemia

  • (ICD-10 C92.1)
  • Chronic myelogenous leukaemia
  • Chronic myelocytic leukaemia
  • Chronic granulocytic leukaemia
  • Chronic Myeloblastic leukaemia
  • Chronic myelomonocytic leukaemia

Non-Hodgkin’s lymphoma

(T or B cells)

  • Burkitt’s lymphoma
  • Mycosis fungoides
  • Adult T cell lymphoma/leukaemia
  • Myeloma
  • Plasma cell malignancy
  • Hairy cell leukaemia
  • Waldenstrom’s macroglobulinaemia
  • Chronic lymphocytic leukaemia/small lymphocytic lymphoma

Hodgkin’s Lymphoma

(B cells)

  • (ICD-10 C81)
  • Hodgkin’s disease
  • Hodgkin lymphoma
 

Myeloma

  • (ICD-10 C90)
  • Plasma cell leukaemia
  • Multiple myeloma
  • Solitary plasmacytoma of bone
  • Extramedullary plasmacytoma
  • Monoclonal gammopathy of undetermined significance