Chronic Lymphocytic Leukemia
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Chronic Lymphocytic Leukemia

(CLL)

En Español (Spanish Version)

Definition

Chronic lymphocytic leukemia (CLL) is a cancer of the blood and bone marrow, in which the bone marrow makes too many lymphocytes (a type of white blood cell). CLL begins in mature lymphocytes and progresses gradually. It may be indolent (slow growing) for many years, causing the patient little or no trouble. It may also eventually progress to a more aggressive form of leukemia, acute lymphoblastic leukemia (ALL). Some forms of CLL, however, may be more serious, in part because of the complications that occur, many of which result from the fact that the leukemia involves the cells of the immune system that are essential in resisting infection.

White Blood Cells

White Blood Cells

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Cancer occurs when cells in the body (in this case, lymphocytes) become abnormal and divide without control or order. Leukemia is cancer of the white blood cells and their parent cells. Leukemia cells do not function normally and cannot do what normal blood cells do, such as fight infections. Other complications can result when the leukemic cells crowd out the other, normal components of the bone marrow, such as those responsible for making red cells, platelets (necessary for blood clotting), and myelocytes (other white cells needed to fight infection).

CLL can also be associated with the presence of chronic lymphocytic lymphoma (small cell non-Hodgkin’s lymphoma , a less aggressive form of lymphoma) because the abnormal cells in each case may come from the same parent cell source. As a result, one of the signs of CLL may be a swelling in the lymph nodes.

Causes

The exact cause of CLL is unknown, but changes in chromosomes (genetic material) that occur during life have been associated with CLL. It is also associated with exposure to radiation and to toxic chemicals, such as benzene (common in agriculture, paint manufacture, and dye manufacture) and Agent Orange (an herbicide used in the Vietnam war).

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.

The following factors increase your chance of developing CLL:

  • Age: Middle age or older
  • Sex: Male
  • Race: White
  • A family history of CLL or cancer of the lymphatic system
  • Having relatives who are Russian Jews or Eastern European Jews
  • Exposure to Agent Orange

Symptoms

Symptoms include:

  • Painless swelling in the neck, underarms, stomach, or groin
  • Tiredness
  • Paleness (a sign of anemia )
  • Pain or a feeling of fullness below the ribs
  • Fever
  • Infection
  • Unexplained weight loss
  • Reduced exercise tolerance
  • Bone pain
  • Enlargement of liver and spleen

Diagnosis

Your doctor will ask about your symptoms and medical history and perform a physical exam. He or she may also check for swelling of the liver; spleen, or lymph nodes in the armpits, groin, or neck. You will likely be referred to an oncologist, a doctor who specializes in treating cancer.

Tests may include the following:

  • Blood tests—to check for changes in the number or appearance of different types of blood cells
  • Bone marrow aspiration—removal of a sample of liquid bone marrow to test for cancer cells
  • Bone marrow biopsy—removal of a sample of liquid bone marrow and a small piece of bone to test for cancer cells
  • Spinal tap—removal of a small amount of cerebrospinal fluid to check for cancer cells
  • Routine microscopic exam—examination of a sample of blood, bone marrow, lymph node tissue, or cerebrospinal fluid
  • Bone, blood marrow, lymph node tissue, or cerebrospinal fluid tests—to distinguish among types of leukemia and to determine whether there are leukemic cells in the lymph nodes or spinal fluid
  • Cytogenetic analysis—a test to look for certain changes of the chromosomes (genetic material) of the lymphocytes; this is used in part to make a specific diagnosis of type, but may also be used to help plan treatment.
  • Chest x-ray—x-rays of the chest that may detect signs of lung infection or cancer in the chest
  • CT scan—a type of x-ray that uses a computer to make pictures of structures inside the body
  • MRI scan—a test that uses magnetic waves to make pictures of structures inside the body
  • Gallium scan and bone scan—injection of a radioactive chemical into the bloodstream to detect areas of cancer or infection
  • Ultrasound—a test that uses sound waves to examine masses and organs inside the body

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include:

Watchful Waiting

In watchful waiting, a doctor monitors the progress of the disease without treating it until symptoms appear to change and become bothersome. During this time, other problems, including infection, can be treated. Watchful waiting is often used in low-risk CLL. Some patients may go for many years before more aggressive treatment is needed.

Radiation Therapy

Radiation therapy involves the use of radiation to kill cancer cells and shrink tumors. The type of radiation used for CLL is known as external radiation therapy. In external radiation therapy, radiation is directed at the tumor from a source outside the body. This treatment is used to treat the brain and spinal cord when indicated, and also to treat lymph node involvement.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms, including pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells.

Surgery

A splenectomy , which is surgery to remove the spleen, may be performed.

Monoclonal Antibody Therapy

Monoclonal antibody therapy uses antibodies made in a laboratory to identify substances on cancer cells or substances on normal cells that may help cancer grow. The antibodies attach to these substances, killing the cancer cells, blocking their growth, or preventing them from spreading.

Chemotherapy With Stem Cell Transplant

Chemotherapy with stem cell transplant as a treatment for CLL is still being tested in clinical trials. In this treatment, chemotherapy is followed by a transplantation of stem cells (immature blood cells) to replace blood-forming cells destroyed by cancer treatment. Stem cells are removed from the blood or bone marrow of the patient or donor, and infused into the patient.

Treatment of Side Effects

Patients will suffer side effects not only from the leukemia, but from therapy. These include a reduction in red blood cells (anemia), reduced numbers of platelets that assist in blood clotting (thrombocytopenia), and decreased numbers of the white blood cells that fight infection.

Anemia may lead to fatigue or, if severe enough, can complicate respiratory or cardiac disease. Thrombocytopenia may lead to bleeding and bruising. Decreased numbers of white blood cells leave a patient more vulnerable to infection.

Your physician may prescribe a number of different treatments to alleviate these side effects. Drugs are available to increase production of normal blood cells. In addition, when counts are particularly low, your doctor may recommend blood transfusions, or modification of your daily activities to reduce the chance of fatigue, bleeding, or infection.

Prevention

There are no guidelines for preventing CLL.

RESOURCES:

American Cancer Society
http://www.cancer.org

The Leukemia and Lymphoma Society
http://www.leukemia-lymphoma.org/hm_lls

National Cancer Institute
http://www.cancer.gov

CANADIAN RESOURCES

BC Cancer Agency
http://www.bccancer.bc.ca/default.htm

Canadian Cancer Society
http://www.cancer.ca

References:

Chronic lymphocytic leukemia (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/CLL/Patient/ . Accessed November 26, 2005.

Detailed guide: leukemia–chronic lymphocytic. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=62 . Accessed November 26, 2005.



Last reviewed January 2008 by Igor Puzanov, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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