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Chronic lymphocytic leukemia (CLL)

CLL; Leukemia - chronic lymphocytic (CLL); Blood cancer - chronic lymphocytic leukemia; Bone marrow cancer - chronic lymphocytic leukemia; Lymphoma - chronic lymphocytic leukemia

 

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 unclear if certain chemicals can cause CLL. Exposure to Agent Orange during the Vietnam War has been linked to a slight increased risk of developing CLL.

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

 

Symptoms

 

Symptoms usually develop slowly. CLL is often found by blood tests done in people for other reasons or who do not have any symptoms.

Symptoms of CLL may 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) despite treatment
  • Loss of appetite or becoming full too quickly (early satiety)
  • Weight loss

 

Exams and Tests

 

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

Tests to diagnose CLL may include:

  • Complete blood count (CBC) with blood cell differential
  • Bone marrow biopsy
  • 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 at changes in the DNA inside the cancer cells may also be done. Results from these tests and from staging tests help your doctor determine your treatment.

 

Treatment

 

If you have early stage CLL, your doctor will just monitor you closely. Treatment is not generally given for early-stage CLL, unless you have:

  • A high-risk or aggressive (grows quickly) type of CLL
  • Infections that keep coming back
  • Leukemia that is rapidly getting worse
  • Low red blood cell or platelet counts
  • Fatigue, loss of appetite, weight loss, or night sweats
  • Swollen lymph nodes

Chemotherapy, including targeted medicines, are used to treat CLL. Your doctor will determine which type of medicines are right for you.

In rare cases, radiation is used for painful and enlarged 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 people with advanced or high-risk CLL. A transplant is the only therapy that offers a potential cure for CLL, but it also has risks. Your doctor will discuss the risks and benefits with you.

You and your health care provider may need to manage other concerns during your leukemia treatment, including:

  • Having chemotherapy at home
  • Managing your pets during chemotherapy
  • Bleeding problems
  • Dry mouth
  • Eating enough calories
  • Safe eating during cancer treatment

 

Support Groups

 

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

 

Outlook (Prognosis)

 

How well a person does depends on the stage of the cancer. About one half of people diagnosed in the early stages of CLL live more than 12 years.

 

Possible Complications

 

Complications of CLL and its treatment may include:

  • Autoimmune hemolytic anemia
  • Bleeding from low platelet count
  • Hypogammaglobulinemia, a condition in which there is a lower level of antibodies than normal, which can increase the risk of infection.
  • Idiopathic thrombocytopenic purpura (ITP)
  • Infections that keep coming back (recur)
  • Fatigue that can range from mild to severe
  • Other cancers, including a much more aggressive lymphoma (Richter's transformation)
  • Side effects of chemotherapy

 

When to Contact a Medical Professional

 

Call a provider if you develop enlarged lymph nodes or unexplained fatigue, bruising, excessive sweating, or weight loss.

 

 

References

Byrd JC, Flynn JM. Chronic lymphocytic leukemia. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:ch 102.

National Cancer Institute: PDQ chronic lymphocytic leukemia treatment. Bethesda, MD: National Cancer Institute. Updated January 29, 2016. www.cancer.gov/cancertopics/pdq/treatment/CLL/healthprofessional. Accessed May 17, 2016.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: non-Hodgkin's lymphomas. Version 2.2016. www.nccn.org/professionals/physician_gls/pdf/nhl.pdf. Accessed March 17, 2016

 
  • Bone marrow aspiration

    Bone marrow aspiration - illustration

    A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.

    Bone marrow aspiration

    illustration

  • Auer rods

    Auer rods - illustration

    Note multiple Auer rods which are found only in acute myeloid leukemias, either myeloblastic or monoblastic. These rods consist of clumps of azurophilic granule material.

    Auer rods

    illustration

  • Chronic lymphocytic leukemia - microscopic view

    Chronic lymphocytic leukemia - microscopic view - illustration

    This is a microscopic view of bone marrow from a person with chronic lymphocytic leukemia; it shows predominantly small, mature lymphocytes.

    Chronic lymphocytic leukemia - microscopic view

    illustration

  • Antibodies

    Antibodies - illustration

    Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

    Antibodies

    illustration

    • Bone marrow aspiration

      Bone marrow aspiration - illustration

      A small amount of bone marrow is removed during a bone marrow aspiration. The procedure is uncomfortable, but can be tolerated by both children and adults. The marrow can be studied to determine the cause of anemia, the presence of leukemia or other malignancy, or the presence of some storage diseases, in which abnormal metabolic products are stored in certain bone marrow cells.

      Bone marrow aspiration

      illustration

    • Auer rods

      Auer rods - illustration

      Note multiple Auer rods which are found only in acute myeloid leukemias, either myeloblastic or monoblastic. These rods consist of clumps of azurophilic granule material.

      Auer rods

      illustration

    • Chronic lymphocytic leukemia - microscopic view

      Chronic lymphocytic leukemia - microscopic view - illustration

      This is a microscopic view of bone marrow from a person with chronic lymphocytic leukemia; it shows predominantly small, mature lymphocytes.

      Chronic lymphocytic leukemia - microscopic view

      illustration

    • Antibodies

      Antibodies - illustration

      Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

      Antibodies

      illustration

    A Closer Look

     

    Talking to your MD

     

      Self Care

       

        Tests for Chronic lymphocytic leukemia (CLL)

         

         

        Review Date: 2/1/2016

        Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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