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Cancer Types

Chronic Lymphocytic Leukemia

Chronic Lymphocytic Leukemia Facts

What is Chronic Lymphocytic Leukemia?

What is Chronic Lymphocytic Leukemia?

Chronic lymphocytic leukemia (CLL), a cancer of the blood, is the second most common type of leukemia. It is caused by the overproduction of immature blood cells in the marrow (the spongy inner mass of bone). These immature cells crowd out healthy cells needed to fight infection and deliver oxygen to the body. CLL progresses slowly, and it may take years for symptoms to appear or for treatment to be needed.

CLL forms because of genetic mutations in lymphocytes, a kind of white blood cell that fights infection. Lymphocytes are found in the blood, and in a clear fluid called lymph that flows through the body and collects in lymph nodes. In people with CLL, lymphocytes are not as good at fighting infection. Over time, they crowd the bone marrow, allowing less room for the cells that make red blood cells, white blood cells, and platelets.

CLL is one of four types of leukemia. Like chronic myelogenous leukemia (CML), CLL progresses slowly. Acute lymphocytic leukemia (ALL) affects the same lymphocytes, but progresses more quickly. Acute myelogenous leukemia (AML) also progresses quickly.

CLL is often found only in the blood and bone marrow. It may involve the lymph nodes, causing swelling in the neck, under the arms, or in the groin, called lymphadenopathy. As CLL progresses the liver and spleen may enlarge. If the bone marrow space is filled up, there is not enough room for the normal marrow cells to form and levels of red cells and platelets fall. It is important for doctors to assess whether the disease is caused by problems with T-cell or with B-cell lymphocytes. The less-common T-cell type of CLL (5% of all cases of CLL) progresses more rapidly than the B-cell form of the disease (95%).

Chronic Lymphocytic Leukemia Risk Factors

Older age can affect the risk of developing chronic lymphocytic leukemia.

Possible risk factors for CLL include the following:

  • Being middle-aged or older, male, or white
  • A family history of CLL or cancer of the lymph system
  • Having relatives who are a Russian Jewish descent or an Eastern European Jewish descent

Chronic Lymphocytic Leukemia, What to Look For

Possible signs of chronic lymphocytic leukemia include swollen lymph nodes and tiredness.

Usually CLL does not cause any symptoms and is found during a routine blood test. Sometimes symptoms occur that may be caused by CLL or by other conditions. A doctor should be consulted if any of the following problems occur:

  • Painless swelling of the lymph nodes in the neck, underarm, stomach, or groin
  • Tiredness that does not go away
  • Pain or fullness below the ribs
  • Fever and infection
  • Weight loss (unexplained)

Chronic Lymphocytic Leukemia Tests

Tests that examine the blood, bone marrow, and lymph nodes are used to detect (find) and diagnose chronic lymphocytic leukemia.

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.

Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.

Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:

  • The number of red blood cells, white blood cells, and platelets
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells
  • The portion of the blood sample made up of red blood cells

Peripheral blood smear: A procedure in which a sample of blood is checked for the presence of blast cells, number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.

Bone marrow biopsy and aspiration: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views the samples under a microscope to look for abnormal cells.

Cytogenetic analysis: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if there are certain changes in the chromosomes in the lymphocytes. For example, sometimes in ALL, part of one chromosome is moved to another chromosome. This is called the Philadelphia chromosome.

Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant (cancerous) lymphocytes began from the B lymphocytes or the T lymphocytes.

Antiglobulin test (also called Coomb's test): A test in which a sample of blood is looked at under a microscope to find out if there are any antibodies on the surface of red blood cells or platelets. These antibodies may react with and destroy the red blood cells and platelets.

Chronic Lymphocytic Leukemia Stages

Staging is the process used to find out how far the cancer has spread. It is important to know the stage of the disease in order to plan the best treatment.

The following tests may be used in the staging process:

  • Chest x-ray
  • MRI (magnetic resonance imaging)
  • CT scan (CAT scan)

The following stages are used for chronic lymphocytic leukemia:

– Stage 0

In Stage 0 Chronic Lymphocytic Leukemia, there are too many lymphocytes in the blood, but there are no other symptoms of leukemia. Stage 0 chronic lymphocytic leukemia is indolent (slow-growing).

Treatment of Stage 0 Chronic Lymphocytic Leukemia is usually watchful waiting.

– Stage I

In Stage I Chronic Lymphocytic Leukemia, there are too many lymphocytes in the blood and the lymph nodes are larger than normal.

Treatment of Stage I chronic lymphocytic leukemia may include the following:

  • Watchful waiting when there are few or no symptoms
  • Chemotherapy with 1 or more drugs, with or without steroids
  • Low-dose external radiation therapy to areas of the body where cancer is found, such as the spleen or lymph nodes
  • A clinical trial of monoclonal antibodies
  • A clinical trial of chemotherapy with stem cell transplantation

– Stage II

In Stage II Chronic Lymphocytic Leukemia, there are too many lymphocytes in the blood, the liver or spleen is larger than normal, and the lymph nodes may be larger than normal.

Treatment of Stage II chronic lymphocytic leukemia may include the following:

  • Watchful waiting when there are few or no symptoms
  • Chemotherapy with 1 or more drugs, with or without steroids
  • Low-dose external radiation therapy to areas of the body where cancer is found, such as the spleen or lymph nodes
  • Radiation therapy to the spleen as palliative therapy to relieve symptoms and improve quality of life
  • A clinical trial of monoclonal antibodies
  • A clinical trial of chemotherapy with stem cell transplantation

– Stage III

In Stage III Chronic Lymphocytic Leukemia, there are too many lymphocytes in the blood and there are too few red blood cells. The lymph nodes, liver, or spleen may be larger than normal.

Treatment of Stage III chronic lymphocytic leukemia may include the following:

  • Watchful waiting when there are few or no symptoms
  • Chemotherapy with 1 or more drugs, with or without steroids
  • Splenectomy
  • Radiation therapy to the spleen as palliative therapy to relieve symptoms and improve quality of life
  • A clinical trial of monoclonal antibodies
  • A clinical trial of chemotherapy with stem cell transplantation

– Stage IV

In Stage IV Chronic Lymphocytic Leukemia, there are too many lymphocytes in the blood and too few platelets. The lymph nodes, liver, or spleen may be larger than normal and there may be too few red blood cells.

Treatment of Stage IV chronic lymphocytic leukemia may include the following:
  • Watchful waiting
  • Chemotherapy with 1 or more drugs, with or without steroids
  • Splenectomy
  • Radiation therapy to the spleen as palliative therapy to relieve symptoms and improve quality of life
  • A clinical trial of monoclonal antibodies
  • A clinical trial of chemotherapy with stem cell transplantation

Chronic Lymphocytic Leukemia Treatment

Different types of treatment are available for patients with Chronic Lymphocytic Leukemia. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Certain factors affect treatment options and prognosis (chance of recovery).


Treatment options depend on:

  • The stage of the disease
  • Red blood cell, white blood cell, and platelet blood counts
  • Whether there are symptoms, such as fever, chills, or weight loss
  • Whether the liver, spleen, or lymph nodes are larger than normal
  • The response to initial treatment
  • Whether the CLL has recurred (come back)
The prognosis (chance of recovery) depends on:
  • Whether there is a change in the DNA and the type of change, if there is one
  • Whether lymphocytes are spread throughout the bone marrow
  • The stage of the disease
  • Whether the CLL gets better with treatment or has recurred (come back)
  • Whether the CLL progresses to lymphoma or prolymphocytic leukemia
  • The patient's general health

– Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.


– Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.


– Surgery

Splenectomy is surgery to remove the spleen.

Chronic Lymphocytic Leukemia Risk Factors

Older age can affect the risk of developing chronic lymphocytic leukemia.

Possible risk factors for CLL include the following:

  • Being middle-aged or older, male, or white
  • A family history of CLL or cancer of the lymph system
  • Having relatives who are a Russian Jewish descent or an Eastern European Jewish descent

What to Look for

Possible signs of chronic lymphocytic leukemia include swollen lymph nodes and tiredness.

Usually CLL does not cause any symptoms and is found during a routine blood test. Sometimes symptoms occur that may be caused by CLL or by other conditions. A doctor should be consulted if any of the following problems occur:

  • Painless swelling of the lymph nodes in the neck, underarm, stomach, or groin
  • Tiredness that does not go away
  • Pain or fullness below the ribs
  • Fever and infection
  • Weight loss (unexplained)

Chronic Lymphocytic Leukemia Tests

Tests that examine the blood, bone marrow, and lymph nodes are used to detect (find) and diagnose chronic lymphocytic leukemia.

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.

Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.

Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:

  • The number of red blood cells, white blood cells, and platelets
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells
  • The portion of the blood sample made up of red blood cells

Peripheral blood smear: A procedure in which a sample of blood is checked for the presence of blast cells, number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.

Bone marrow biopsy and aspiration: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views the samples under a microscope to look for abnormal cells.

Cytogenetic analysis: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if there are certain changes in the chromosomes in the lymphocytes. For example, sometimes in ALL, part of one chromosome is moved to another chromosome. This is called the Philadelphia chromosome.

Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant (cancerous) lymphocytes began from the B lymphocytes or the T lymphocytes.

Antiglobulin test (also called Coomb's test): A test in which a sample of blood is looked at under a microscope to find out if there are any antibodies on the surface of red blood cells or platelets. These antibodies may react with and destroy the red blood cells and platelets.

Stages of Chronic Lymphocytic Leukemia

Staging is the process used to find out how far the cancer has spread. It is important to know the stage of the disease in order to plan the best treatment.

The following tests may be used in the staging process:

  • Chest x-ray
  • MRI (magnetic resonance imaging)
  • CT scan (CAT scan)

The following stages are used for chronic lymphocytic leukemia:

– Stage 0

In Stage 0 Chronic Lymphocytic Leukemia, there are too many lymphocytes in the blood, but there are no other symptoms of leukemia. Stage 0 chronic lymphocytic leukemia is indolent (slow-growing).

Treatment of Stage 0 Chronic Lymphocytic Leukemia is usually watchful waiting.

– Stage I

In Stage I Chronic Lymphocytic Leukemia, there are too many lymphocytes in the blood and the lymph nodes are larger than normal.

Treatment of Stage I chronic lymphocytic leukemia may include the following:

  • Watchful waiting when there are few or no symptoms
  • Chemotherapy with 1 or more drugs, with or without steroids
  • Low-dose external radiation therapy to areas of the body where cancer is found, such as the spleen or lymph nodes
  • A clinical trial of monoclonal antibodies
  • A clinical trial of chemotherapy with stem cell transplantation

– Stage II

In Stage II Chronic Lymphocytic Leukemia, there are too many lymphocytes in the blood, the liver or spleen is larger than normal, and the lymph nodes may be larger than normal.

Treatment of Stage II chronic lymphocytic leukemia may include the following:

  • Watchful waiting when there are few or no symptoms
  • Chemotherapy with 1 or more drugs, with or without steroids
  • Low-dose external radiation therapy to areas of the body where cancer is found, such as the spleen or lymph nodes
  • Radiation therapy to the spleen as palliative therapy to relieve symptoms and improve quality of life
  • A clinical trial of monoclonal antibodies
  • A clinical trial of chemotherapy with stem cell transplantation

– Stage III

In Stage III Chronic Lymphocytic Leukemia, there are too many lymphocytes in the blood and there are too few red blood cells. The lymph nodes, liver, or spleen may be larger than normal.

Treatment of Stage III chronic lymphocytic leukemia may include the following:

  • Watchful waiting when there are few or no symptoms
  • Chemotherapy with 1 or more drugs, with or without steroids
  • Splenectomy
  • Radiation therapy to the spleen as palliative therapy to relieve symptoms and improve quality of life
  • A clinical trial of monoclonal antibodies
  • A clinical trial of chemotherapy with stem cell transplantation

– Stage IV

In Stage IV Chronic Lymphocytic Leukemia, there are too many lymphocytes in the blood and too few platelets. The lymph nodes, liver, or spleen may be larger than normal and there may be too few red blood cells.

Treatment of Stage IV chronic lymphocytic leukemia may include the following:
  • Watchful waiting
  • Chemotherapy with 1 or more drugs, with or without steroids
  • Splenectomy
  • Radiation therapy to the spleen as palliative therapy to relieve symptoms and improve quality of life
  • A clinical trial of monoclonal antibodies
  • A clinical trial of chemotherapy with stem cell transplantation

Types of Treatment for Chronic Lymphocytic Leukemia

Different types of treatment are available for patients with Chronic Lymphocytic Leukemia. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Certain factors affect treatment options and prognosis (chance of recovery).


Treatment options depend on:

  • The stage of the disease
  • Red blood cell, white blood cell, and platelet blood counts
  • Whether there are symptoms, such as fever, chills, or weight loss
  • Whether the liver, spleen, or lymph nodes are larger than normal
  • The response to initial treatment
  • Whether the CLL has recurred (come back)
The prognosis (chance of recovery) depends on:
  • Whether there is a change in the DNA and the type of change, if there is one
  • Whether lymphocytes are spread throughout the bone marrow
  • The stage of the disease
  • Whether the CLL gets better with treatment or has recurred (come back)
  • Whether the CLL progresses to lymphoma or prolymphocytic leukemia
  • The patient's general health

 

– Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.


– Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the spinal column, a body cavity such as the abdomen, or an organ, the drugs mainly affect cancer cells in those areas. The way the chemotherapy is given depends on the type and stage of the cancer being treated.


– Surgery

Splenectomy is surgery to remove the spleen.

Side Effects of Chronic Lymphocytic Leukemia

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