Chronic Lymphocytic Leukemia

Leukemia is a type of cancer that affects the blood and blood-forming tissues. There are many types of leukemia, each affecting different kinds of blood cells. Chronic lymphocytic leukemia, or CLL, is a cancer of the lymphocytes.

Lymphocytes are a type of white blood cell. CLL affects B lymphocytes, which are also called B cells. Normal B cells circulate in the blood and help your body fight infection. Cancerous B cells do not fight infections as normal B cells do. As the number of cancerous B cells gradually increases, they crowd out normal lymphocytes and cause bone marrow failure.

There is no known cause of CLL.

This type of cancer is rarely diagnosed in individuals under the age of 40 and is typically found in those over 70 years old. It is more common in Jewish people of Russian or East European descent and affects more men than women.

Some patients may not have any symptoms, and the cancer may only be discovered during a routine blood test. When people do exhibit symptoms, they typically include

• fatigue
• fever
• frequent infections or illness
• unexplained, unintended weight loss
• night sweats

Your doctor may also find an enlarged spleen, liver, or lymph nodes when doing a physical examination, indicating that the cancer may have spread to these organs. These findings are common in advanced CLL and may be experienced as sometimes-painful lumps in the neck or fullness and swelling of the belly.

Testing & Diagnosis

If your doctor suspects you may have CLL, various tests may be done to confirm the diagnosis. The following tests are typically ordered:

• complete blood count (CBC) with white blood cell differential to measure the different cells of the blood and look at the numbers of different types of white blood cells; patients with CLL have more lymphocytes than normal
• bone marrow biopsy: a needle with a special tube is inserted into your hip or breastbone to get a sample of your bone marrow
• CT scan (computed tomography) to look for swollen lymph nodes in the chest or abdomen
• immunoglobulin testing to determine if you have enough antibodies to fight infections

Staging

If you are diagnosed with CLL, further testing will be done to gauge the extent of disease. This helps your doctor classify the cancer into a stage, which will determine treatment. Staging involves getting a specific blood lymphocyte count; checking for enlarged lymph nodes, spleen, or liver; and obtaining a red blood cell count.

The stages of CLL are stage 0 through stage IV, in order of ascending severity. The stages are then also grouped into levels of risk (for treatment purposes). Stage 0 is low-risk, stages I and II are intermediate-risk, and stages III and IV are high-risk, explains the American Cancer Society (ACS).

The treatment for low-risk CLL typically involves watchful waiting. However, there are instances in which treatment is used, such as when the patient has

• persistent, recurrent infections
• low blood counts
• fatigue or night sweats
• painful lymph nodes

Chemotherapy is the principal treatment for CLL. This involves using medications to kill cancer cells. These drugs can be given intravenously or orally, depending on the exact medications. If painful lymph nodes are present, radiation may be used to shrink them and relieve pain. Blood transfusions may be necessary to increase your blood counts.

In a patient with high-risk CLL, a bone marrow or peripheral blood stem cell transplant may be an option. This involves taking stem cells from either the bone marrow or blood of a donor, usually a family member, and transplanting it into the patient so that it can establish a new immune system.

Survival rates vary widely, and factors that can influence survival include an individual’s age, gender, any chromosome abnormalities, and cancer cell characteristics. Approximately half of patients who are diagnosed with early-stage CLL live for more than 12 years.

During chemotherapy, your immune system is weakened, leaving you more vulnerable to infections. Fatigue and other side effects of chemotherapy can occur, including other cancers. Abnormal levels of antibodies and low blood counts may also occur during treatment.

Other common side effects of chemotherapy include

• hair loss
• mouth sores
• loss of appetite
• nausea and vomiting

Talk with your doctor about the expected side effects of your treatment. He or she can tell you the symptoms to watch for that warrant medical attention.