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    Chronic lymphocytic leukemia (CLL)

    CLL; Leukemia - chronic lymphocytic (CLL)

    Chronic lymphocytic leukemia (CLL) is cancer of a type of white blood cells called lymphocytes. These cells are found in the bone marrow and other parts of the body. Bone marrow is the soft tissue in the center of bones that helps form all blood cells.

    CLL causes a slow increase in a certain type of white blood cells called B lymphocytes, or B cells. Cancer cells spread through the blood and bone marrow. CLL can also affect the lymph nodes or other organs such as the liver and spleen. CLL eventually can cause the bone marrow to lose its function.

    Causes

    The cause of CLL is unknown. There is no link to radiation. It is not clear whether certain chemicals cause CLL. But exposure to Agent Orange during the Vietnam War has been linked to an increased risk of getting CLL.

    CLL usually affects older adults, especially those older than age 60.Persons under age 45 rarely get it. CLL is more common in whites than in other ethnic groups. It is more common in men than in women. Some persons with CLL have family members with the disease.

    Symptoms

    Symptoms usually develop slowly.CLLis often foundby blood tests done in people for other reasons or who do not have any symptoms.

    Symptoms of CLL include:

    • Abnormal bruising (if platelets are low)
    • Enlarged lymph nodes, liver, or spleen
    • Excessive sweating, night sweats
    • Fatigue
    • Fever
    • Infections that keep coming back (recur)
    • Loss of appetite or becoming full too quickly (early satiety)
    • Weight loss

    Exams and Tests

    Patients with CLL usually have a high white blood cell count.

    Tests to diagnose CLL include:

    • Complete blood count (CBC) with white blood cell differential
    • Bone marrow biopsy
    • CT scan of the chest, abdomen, and pelvis
    • Immunoglobulin testing
    • Flow cytometry test of the white blood cells

    If your doctor discovers you have CLL, tests will be done to see how much the cancer has spread. This is called staging.

    Tests that look atchanges in DNAinside the cancer cells may also be done. Results from these tests can from staging testshelp your doctor determine your treatment.

    Treatment

    If you have early stage CLL, your doctor will monitor you closely. Usually, no medicines or other treatmentis given for early-stage CLL, unless you have:

    • A high-risk type of CLL
    • Infections that keep coming back
    • Leukemia that is rapidly getting worse
    • Low redblood cellsorplatelet counts
    • Fatigue, loss of appetite, weight loss, or night sweats
    • Painful swollen lymph nodes

    Chemotherapy medicines are used to treat CLL. Your doctor will determine which ones are right for you.

    In rare cases, radiation is used for painful andenlarged lymph nodes.

    Blood transfusions or platelet transfusions may be required if blood counts are low.

    Bone marrow or stem cell transplantation may be used in younger patients with advanced or high-risk CLL. A transplant is the only therapy that offers a potential cure for CLL.

    Support Groups

    cancer support group

    Outlook (Prognosis)

    How well a patient does depends on the stage of the cancer. About half of patients diagnosed in the early stages ofCLL live more than 12 years.

    Possible Complications

    • Autoimmune hemolytic anemia
    • Bleeding from low platelet count
    • Hypogammaglobulinemia, a condition in which you have lower levels of antibodies, which increases your risk of infection
    • Idiopathic thrombocytopenic purpura (ITP)
    • Infections that keep coming back (recur)
    • Overwhelming fatigue
    • Other cancers, including a much more aggressive lymphoma (Richter’s transformation)
    • Side effects of chemotherapy

    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

    Kantarjian H, O'Brien S. The chronic leukemias. In: Goldman L, SchaferAI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 190.

    Lin TS, Awan FT, Byrd JC. Chronic lymphocytic leukemia. In: Hoffman R, Benz EJ Jr, Silberstein LE, et al., eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 76.

    National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Non-Hodgkin’s Lymphomas. Version 1.2013. Available at http://www.nccn.org/professionals/physician_gls/pdf/nhl.pdf. Accessed January 2, 2013.

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          Tests for Chronic lymphocytic leukemia (CLL)

          Review Date: 2/8/2013

          Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Blackman, Stephanie Slon, and Nissi Wang.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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