The chronic leukemias. Clinical picture, diagnosis, and management.

The chronic leukemias have an annual incidence in the United States of about 12,000 cases. The most common types are chronic myelogenous leukemia (CML) and chronic lymphocytic leukemia (CLL). Less common are hairy cell leukemia (HCL) and prolymphocytic leukemia (PLL). All forms have an insidious onset and vague, non-specific presenting symptoms, eg, fatigue, malaise, night sweats, weight loss. Chemotherapy is the initial treatment for CML and CLL; splenectomy, splenic irradiation, and leukapheresis may also be helpful. Splenectomy is the preferred treatment for HCL. Until recently all chronic leukemias have been ultimately fatal, but the new approach of allogeneic bone marrow transplantation now used in some cases of CML may prove to be curative if done before the disease has progressed too far.