CLL? SLL?

Over the last 6 or 8 weeks, I had been asking questions such as: What is a small clonal population and what does that mean? Why are my counts (WBC & ALC) in the normal range? Without lymphocytosis, can this be CLL? If not, then what is it?"

I requested quantitative reports from Beth Israel Deaconnes Medical Center in Boston where the diagnosis was done last summer. They were waiting for me when I returned from Canada and I discovered some answers to some questions:

• The bone marrow biopsy/aspirate showed 33% lymphocytes -- that answers the "small clonal population" question as according to MD Anderson, "lymphocytes >30% are diagnostic for CLL.
• The flow cytometry studies showed the "presence of a Kappa restricted CD20 dim, CD23+, CD5 B-cell population that is immunophenotypically consistent with involvement by chronic lymphocytic leukemia/small cell lymphocytic lymphoma."
• CD38 expression is not detected (and that is a good thing!!!!)
• CD5+ B-cells express ZAP-70 (not a good thing ---- but ---- it could be a lab error)
• Molecular cytogenetic - four DNA probes -- all in normal ranges (another good thing)

So here is what I now understand: CLL and SLL are biologically and morphologically the same disease but present differently: CLL in the blood and SLL in the lymphatic system.