Chronic Lymphocytic Leukemia

Chronic Lymphocytic Leukemia

Definition

Chronic lymphocytic leukemia (CLL), is a kind of cancer that occurs in a specialized white blood cell called a lymphocyte. In the bone marrow, where all blood cells are made, immature lymphocytes acquire a genetic abnormality, cease to function normally, and multiply in uncontrolled fashion. This is known as "malignant" change - that is, cancer of the lymphocytes. CLL is slow to develop and may affect a person for many years before symptoms are noticed.

What is going on in the body?

When the malignant cells grow in the bone marrow, normal bloods cells are often destroyed or crowded out. Having fewer normal white cells can cause the person to become infected easily. The infections may be serious and life-threatening. Having fewer platelets means that the person may bruise or bleed easily. Anemia, or low numbers of red blood cells, can make the person weak and easily tired.
When the malignant white cells multiply quickly, some of them leave the bone marrow and travel throughout the body in the bloodstream. This often leads to disease in other parts of the body.

Risks

What are the causes and risks of the disease?

No one knows what causes CLL.

Prevention

What can be done to prevent the disease?

There is no known way to prevent CLL.

Diagnosed

How is the disease diagnosed?

The diagnosis of CLL begins with a medical history and physical exam. A blood sample is examined to see if it contains malignant white cells. Swollen lymph nodes may also be removed for study. Special genetic studies on the blood and lymph nodes will help to confirm CLL. A sample of the bone marrow can be removed and analyzed as well. This procedure is known as a bone marrow biopsy.

Long Term Effects

What are the long-term effects of the disease?

Sometimes CLL can be become very active very quickly. Most of the time, however, CLL grows very slowly over a number of years. As CLL becomes more active, it will gradually weaken the person and cause serious problems. When the person begins to have symptoms, such as infection or swelling lymph nodes, he or she needs to be treated. Without treatment, active CLL can cause death.

Other Risks

What are the risks to others?

CLL is not contagious and poses no risk to others.

Treatments

What are the treatments for the disease?

The treatment of CLL is usually started only when the person develops symptoms. If the person has no symptoms, he or she may simply be monitored. Treatment of CLL includes the following:
  • chemotherapy, which can sometimes make the CLL completely resolve
  • corticosteroids to control the growth of CLL cells
  • radiation therapy, which can shrink swollen lymph nodes

Side Effects

What are the side effects of the treatments?

Chemotherapy causes side effects that are generally mild and temporary. Hair loss and mild nausea are common. Corticosteroids can cause puffiness and weight gain over time. Steroids can also interfere with the body's ability to use glucose. This means the person may develop a form of diabetes that will clear up when the person stops taking steroids. Radiation therapy may cause the skin over the area being treated to turn red.

After Treatment

What happens after treatment for the disease?

After treatment, the person will be monitored closely because CLL usually comes back. At that time, treatment will be started again. Different types of treatment can be used if one type is no longer helpful.

Monitor

How is the disease monitored?

Frequent blood samples will be taken to watch for CLL cells in the bloodstream. A physical exam will also be done regularly to see if the lymph nodes are swelling again. Any new or worsening symptoms should be reported to the healthcare provider.

Sources

Khouri, I, Sanchez, F.G., Deisseroth, A.(1997). Leukemias in Cancer: Principles and Practice of Oncology. 5th Edition DeVita, V.T. (ed). J.B. Lippincott: Philadelphia. Pp. 2287-2321.

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