Review Question - QID 213462

A 67-year-old man presents to his primary care provider reporting several months of generalized fatigue that does not improve with rest. Additionally, he has noted that he has lost 10 pounds in the past 3 months, which he attributes to being too tired to finish his meals. The patient has been otherwise healthy and takes no medications aside from a daily multivitamin. He does not report any sleep irregularities, and his wife has told him that she does not notice any snoring or apnea. He does not report any other symptoms or recent infections, and has not noticed any fevers at home. On exam, the patient is thin and appears his stated age. His temperature is 100.2°F (37.9°C), blood pressure is 116/76 mmHg, pulse is 72/min, and respirations are 12/min. Lymph node exam is notable for symmetrically enlarged axillary lymph nodes bilaterally. His abdomen is soft and nontender with no palpable masses. On his labs, his hemoglobin is 12.0 g/dL, and his leukocyte count is 24,000/mm^3. A peripheral blood smear is shown in Figure A. Which of the following is likely characteristic of this patient’s disease?