An 80-year-old woman presents to her primary care physician complaining of increased overall fatigue with decreased appetite and early satiety over the past 6 months. On physical exam, the patient appears pallid. There is no evidence of lymphadenopathy, but splenomegaly is evident on palpation. A lymphoid neoplasm is suspected.

The patient has a history of hypertension and high cholesterol, both of which are pharmacologically controlled. She retired 15 years ago but was a hairdresser for 40 years and has been coloring her hair since the age of 20.

Laboratory testing shows lymphocytes = 5500/µL; hemoglobin = 10 g/dL. CT confirms splenomegaly and no nodal involvement. Immunophenotyping is performed and shows CD5+, CD19+, CD20+, CD25+, CD23 low, CD200 low, t(11;14) translocation, IGHV mutated as well as FMC-7 + and cyclin D overexpression.