Chronic lymphocytic leukemia (CLL)
Definition
Chronic lymphocytic leukemia is cancer of the white blood cells (lymphocytes).
See also:- Acute lymphocytic leukemia (ALL)
- Chronic myelogenous leukemia (CML)
- Leukemia
Alternative Names
CLL; Leukemia - chronic lymphocytic (CLL)Causes
Chronic lymphocytic leukemia (CLL) causes a slow increase in the number of white blood cells called B cells in the bone marrow. The cancerous cells spread from the blood marrow to the blood, and can also affect the lymph nodes and other organs. CLL causes the bone marrow to fail and weakens the immune system.
The reason for this increase in B cells is unknown. There is no link to radiation, cancer-causing chemicals, or viruses.
CLL primarily strikes adults. The average age of a patient with this type of leukemia is 70. It is rarely seen in people younger than 40. The disease is more common in Jewish people of Russian or East European descent, and is uncommon in Asians.
Symptoms
Symptoms usually develop gradually. Many cases of CLL are detected by routine blood tests in people who do not have symptoms.
Symptoms that can occur include:
- Abnormal bruising (occurs late in the disease)
- Enlarged lymph nodes, liver, or spleen
- Excessive sweating, night sweats
- Fatigue
- Loss of appetite
- Unintentional weight loss
Exams and Tests
Patients with CLL have a higher-than-normal white blood cell count.
Tests to diagnose CLL include:
- Complete blood count (CBC)
- Bone marrow aspiration
- Flow cytometry
- Serum protein electrophoresis
If your doctor discovers you have CLL, tests will be done to see how much the cancer has spread. This is called staging. There are two systems to stage CLL.
One system uses numbers to group CLL into low-, intermediate-, and high-risk categories. Generally, the higher the stage number, the more advanced the cancer. Another system uses letters to stage CLL according to how many lymph node groups are affected and whether or not you have a drop in red blood cells or platelets.
Treatment
Early stage disease often requires no specific treatment, but it is important to be closely monitored by your doctor.
Chemotherapy may be needed if fatigue, anemia, thrombocytopenia, or lymph node swelling occurs. Several chemotherapy drugs are commonly used to treat CLL. Fludarabine, cyclophosphamide (Cytoxan), and rituximab (Rituxan) may be used. Rituxan may be used alone or in combination with traditional chemotherapy.
Alemtuzumab (Campath) is approved for treatment of patients with CLL that have not responded to fludarabine.
Rarely, radiation may be used for enlarged lymph nodes. Blood transfusions or platelet transfusions may be required. Stem cell transplantation may be used in advances stages of CLL.
Outlook (Prognosis)
The outlook depends on the stage of the disease. Half of patients diagnosed in the earliest stages of the disease live more than 12 years. Several new tests that look at cell and genetic changes can help predict life expectancy.
Possible Complications
- Hypogammaglobulinemia (reduced levels of antibodies) -- increases the risk of infection
- Other cancer
- Side effects of chemotherapy
- Bleeding from low platelets
- Fatigue from anemia
- Autoimmune hemolytic anemia
- Idiopathic thrombocytopenic purpura (ITP)
When to Contact a Medical Professional
Call health care provider if you develop enlarged lymph nodes or unexplained fatigue, bruising, excessive sweating, or weight loss.
References
American Cancer Society. Cancer Facts and Figures 2008. Atlanta, Ga: American Cancer Society; 2008.
Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004:2921-2940.
Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: pp. 1397-1407.
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
