Chronic Lymphocytic Leukemia
Chronic lymphocytic leukemia (CLL) is a cancer of the blood and bone marrow. Lymphocytes are a type of white blood cell. With CLL the bone marrow makes too many of these cells. CLL begins in mature lymphocytes. It progresses gradually. It may be indolent (slow growing) for many years. You may have little or no trouble. It may also eventually progress to a more aggressive form of leukemia, acute lymphoblastic leukemia (ALL). Some forms of CLL may be more serious. This is because leukemia involves the cells of the immune system. These cells that are needed to resist infection.
White Blood Cells
Cancer occurs when cells in the body become abnormal. They divide without control or order. Leukemia is cancer of the white blood cells and their parent cells. Leukemia cells do not function normally. They cannot do what normal blood cells do. In this case they can not fight infections. This means that the person is more likely to become infected with viruses or bacteria. The cancerous cells also overgrow the bone marrow. This forces other normal components, like platelets out. Platelets are needed to help the blood clot. As a result, people with leukemia may bleed more easily.
CLL can also be associated with the presence of chronic lymphocytic lymphoma. This is a small cell non-Hodgkin’s lymphoma]]> . The abnormal cells in both cases 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.
Lymph Nodes in the Head and Neck
The exact cause of CLL is unknown. Changes in chromosomes 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)
- Agent Orange (an herbicide used in the Vietnam war)
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
- Painless swelling in the neck, underarms, stomach, or groin
- Paleness (a sign of anemia]]> )
- Pain or a feeling of fullness below the ribs
- Unexplained weight loss
- Reduced exercise tolerance
- Bone pain
- Enlargement of liver and spleen
Your doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor may also check for swelling of the liver; spleen, or lymph nodes. The nodes may be in the armpits, groin, or neck. You will likely be referred to an oncologist. This is 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 and 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
Talk with your doctor about the best plan for you. Treatment options include:
A doctor keeps an eye on the progress of the disease. Other treatment is not started until symptoms appear to change and become a problem. 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.
This therapy is the use of radiation to kill cancer cells and shrink tumors. For CLL, external radiation therapy is used. The radiation is directed at the tumor from outside the body. This treatment is used to treat the brain and spinal cord when indicated. It is also used to treat lymph node issues.
Chemotherapy]]> is the use of drugs to kill cancer cells. It may be given by pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body. It kills mostly cancer cells, but also some healthy cells.
A ]]>splenectomy]]> may be done. This is a surgery to remove the spleen.
Monoclonal Antibody Therapy
This therapy uses antibodies made in a lab. The antibodies help to identify substances on cancer cells or on normal cells that may help cancer grow. The antibodies attach to these substances. This kills 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 that can lead to ]]>anemia]]>
- Reduced numbers of platelets that assist in blood clotting (thrombocytopenia)
- Decreased numbers of the white blood cells that fight infection
Anemia may lead to fatigue. If severe enough it 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.
Drugs are available to increase production of normal blood cells. When counts are particularly low, your doctor may recommend blood transfusions. You may also need to modify your daily activities to reduce the chance of fatigue, bleeding, or infection.
American Cancer Society
The Leukemia and Lymphoma Society
National Cancer Institute
BC Cancer Agency
Canadian Cancer Society
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 September 2009 by ]]>Mohei Abouzied, 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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