Chronic Lymphocytic Leukemia

WHAT YOU SHOULD KNOW:

• Chronic lymphocytic leukemia (CLL) is cancer in your blood and bone marrow. Bone marrow is the soft, spongy tissue inside your bone. Your bone marrow makes the cells found in your blood, including your white blood cells. Lymphocytes are a type of white blood cell that attack infections from germs called bacteria or viruses. With CLL, bone marrow makes damaged lymphocytes that may build up in your lymph nodes, liver, and spleen. Your lymph nodes are small organs made of tissue that fight infection. Your liver and spleen are organs located in your upper abdomen (stomach). Your bone marrow may also stop making enough other cells, such as platelets and red blood cells.
  
  
• Caregivers do not know what causes CLL. Your caregiver uses blood tests and a physical exam to diagnose your CLL. You may have symptoms such as bleeding, bruising, and fever (high body temperature). Your lymph nodes, spleen, and liver may become larger. You may need cancer treatments, including chemotherapy, radiation therapy, or a cell transplant. There is no cure for CLL. Treatment may help your blood cells become normal again and decrease your risk of bleeding or getting infections. Treatment may also help decrease the size of your liver or spleen.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• Chemotherapy may injure your skin or give you a rash. You may have nausea (upset stomach), vomiting (throwing up), diarrhea (loose, watery stool), or fevers. You may feel more tired than usual. You may get infections easily. After a stem cell transplant, your body may not accept the new cells. Chemotherapy may cause an allergic reaction. Chemotherapy may also kill some of your healthy blood cells. You may have a fast heartbeat or it may be hard to breathe.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening. Your CLL might not respond to treatment and you may die.
  
  
• There is no cure for CLL. Without treatment, your CLL may get worse. You may have more damaged lymphocytes. If you get anemia (not enough red blood cells), your organs or tissues may not get enough oxygen. You may also get thrombocytopenia (not enough platelets) and you may bleed too much. Your body organs may become damaged and stop working properly. You may get serious infections and you may die. Talk to your caregiver if you have questions or concerns about your condition, treatment, or care.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

IV:

An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.

Medicines:

You may be given the following medicines:

• Antibiotics: Antibiotic medicine helps your body fight infections. You may get this medicine as a pill or in your IV.
  
  
• Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.
  
  
• Immune globulins: Immune globulins can be used to treat many different problems. It may be given to help your immune system fight infection. It may also help if your body does not produce enough of certain kinds of blood cells. This medicine may help if your system fights something in your blood or body that it should not. Ask your caregiver for more information about how immune globulin medicine may help you.
  
  
• Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
  
  
  • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.
    
    
  • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.
  
  
• Steroids: Steroid medicine may be combined with chemotherapy treatment. You may need steroids to help you make healthy red blood cells.

Treatment options:

• Chemotherapy:
  
  
  • This medicine, often called chemo, is used to treat cancer. It works by killing tumor cells. Chemotherapy may also be used to shrink lymph nodes that have cancer in them. Once the tumor is smaller, you may need surgery to cut out the rest of the cancer.
    
    
  • Many different chemotherapy medicines are used to treat cancer. You may need blood tests often. These blood tests show how your body is doing and how much chemotherapy is needed. Chemotherapy can have many side effects. Caregivers will watch you closely and will work with you to decrease side effects. Chemotherapy can cure some cancers. Even if the chemotherapy does not cure your cancer, it may help you feel better or live longer.
  
  
• Biologic therapy for cancer: Biologic therapy is medicine given to help your body fight growing cancer cells. It may also make cancer cells weaker and easier to kill. You may need this medicine more than once. You may feel like you have the flu during this therapy.
  
  
• Radiation therapy: This is a treatment using x-rays or gamma rays to treat cancer. Radiation kills cancer and keeps the cancer from spreading. It also keeps cancer cells from dividing into new cells, which is one way cancer spreads. Lymph nodes with cancer are also treated with radiation. It may also be given with chemotherapy. Radiation may shrink your lymph nodes and spleen.
  
  
• Blood transfusion: You may need a blood transfusion if you need more healthy blood cells in your body. During a blood transfusion, you will get whole blood, or parts of blood through an IV. Many people are worried about getting AIDS, hepatitis, or West Nile Virus from a blood transfusion. The risk of this happening is rare. Blood banks test all donated blood for AIDS, hepatitis, and West Nile Virus. If you refuse a blood transfusion, your condition may get worse, and you may die.
  
  
• Peripheral stem cell transplant: During a peripheral stem cell transplant, blood cells called stem cells are put back into your body. To do this, blood is first taken from your body. The blood is then put through a process called apheresis. During apheresis, the stem cells are taken out of the blood. The stem cells are then put back into your body and they usually return to the bone marrow. In the bone marrow, stem cells can grow and become white blood cells to help fight infection.

Tests:

• Blood tests: Your caregiver will do blood tests to check how many of your lymphocytes are damaged. Blood tests will also count your red blood cells and platelets. Your caregiver may use blood tests to see if your CLL has damaged any of your organs. You may also have blood tests to see if you have an infection. Your blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. You may need to have blood drawn more than once.
  
  
• Bone marrow biopsy: This is when a sample of bone marrow is removed and sent to a lab for tests. The skin over your upper hipbone is first cleaned. Caregivers put numbing medicine into your skin so you will have little pain. A bandage is put on the biopsy area after the tissue sample is taken. A bone marrow biopsy may show if your bone marrow is making enough healthy blood cells. It may also help your caregiver figure out what may be causing abnormal blood tests.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. You may need a chest x-ray to see if you have a lung infection, such as pneumonia. A chest x-ray may also show if your cancer has spread to your chest.
  
  
• Ultrasound: An ultrasound is a simple test that looks inside of your body. Sound waves are used to show pictures of your organs and tissues on a TV-like screen. Your caregiver may use this test to check the size of your spleen, liver, or lymph nodes.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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