Chronic Lymphocytic Leukemia

What is chronic lymphocytic leukemia?

Chronic lymphocytic leukemia (CLL) is cancer in your blood and bone marrow. Lymphocytes are a type of white blood cell (WBC) that prevent and fight infections. Your bone marrow makes damaged lymphocytes and your body has trouble fighting infections if you have CLL. It may prevent your bone marrow from making other blood cells and cause bleeding or infections.

What causes CLL?

The cause is unknown. You may be more likely to develop CLL if someone in your family has had it. CLL is also more common in older people. You may be more likely to get CLL if you are male, but females may also have CLL.

What are the signs and symptoms of CLL?

You may have no symptoms during the early stages of CLL. Over time, you may start to have some of the following:

• Easy bleeding or bruising
  
  
• Many illnesses, such as colds, coughs, or flu
  
  
• Low energy or feeling very tired
  
  
• Fever
  
  
• Weight loss without trying
  
  
• Night sweats
  
  
• Small lumps (swollen lymph nodes) in your neck, armpits, or groin
  
  
• Abdominal swelling, pain, or discomfort

How is CLL diagnosed?

Your caregiver will ask you about your symptoms and examine you. He will feel your abdomen to see if your liver or spleen is larger than normal. An enlarged liver or spleen is a sign that your body has too many WBCs. He will check your neck, armpits, and groin for large lymph nodes. You may need the following:

• Blood tests: These tests check to see if your lymphocytes are normal or damaged. They also count the number of each type of blood cell (RBCs, WBCs, platelets).
  
  
• Ultrasound: 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.
  
  
• Bone marrow biopsy: During this procedure, a small amount of bone marrow is taken from the bone in your hip. This test helps caregivers find out if your bone marrow is making enough healthy blood cells.

How is CLL treated?

Your caregiver will use information from blood tests and your physical exam to determine if your CLL is early, middle, or late stage. Then, you and your caregiver will decide on the best treatment plan. You might not have treatment if you are in an early stage and do not have symptoms. If you do not have treatment, your caregiver will ask you to come back for follow-up visits. These visits will include a physical exam and blood tests. He will check to see if you are still in the same stage. He will also decide whether you should begin treatment. You may have one or more of the following treatments:

• 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.
  
  
• 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: This is a treatment using x-rays or gamma rays to treat cancer. Radiation may be given with chemotherapy. Radiation kills cancer and keeps the cancer from spreading. Lymph nodes with cancer are also treated with radiation. Radiation may shrink your lymph nodes and spleen.
  
  
• Bone marrow or stem cell transplant: During this procedure, bone marrow or stem cells are put in your blood through an IV. The stem cells should go to your bone marrow and begin to make new blood cells.

• Medicines:
  
  
  • Antibiotics: Antibiotic medicine helps your body fight infections.
    
    
  • Immune globulins: You may need immune globulins to treat or prevent an infection.
    
    
  • Steroids: Steroid medicine may be combined with chemotherapy treatment. You may need steroids to help you make healthy red blood cells.
  
  

How will I respond to treatment?

There are different ways that you may react to treatment. You may have stable disease, which means your body does not change stages with or without treatment. You may respond one way to treatment and then have a different response later. You may have any of the following:

• Complete remission: If you have complete remission after treatment, your blood tests become normal again. Your spleen, liver, or lymph nodes will be normal sized. You will not have symptoms.
  
  
• Partial remission: You may have a partial response to treatment. During partial remission, you may still have signs and symptoms of CLL. Your body will have fewer damaged lymphocytes than before treatment. Your body may produce enough red blood cells. Your liver, spleen, and lymph nodes may become smaller.
  
  
• Minimal residual disease: This means that you have very few cancer cells left in your body.
  
  
• Progressive disease: If you have progressive disease, your CLL is getting worse. Your body may not be making enough red blood cells or platelets. Your lymph nodes, spleen, and liver may get larger.
  
  
• Relapse: You may relapse after having a complete or partial response to treatment. This means that you have signs and symptoms of progressive disease. Your blood tests may become abnormal again. Your lymph nodes, spleen, and liver may get larger.
  
  
• Refractory disease: Refractory disease means that you do not get better with treatment. You may need other treatments, such as a stem cell transplant.

What are the risks of CLL?

• Chemotherapy may injure your skin or give you a rash. You may have nausea, vomiting, diarrhea, or fevers. You may feel more tired than usual. You may get infections easily. 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. After a stem cell transplant, your body may not accept the new cells.
  
  
• 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. You may bleed too much. Your organs may become damaged and stop working properly. You may get serious infections and you may die.

Where can I find support and more information?

• American Cancer Society
  250 Williams Street
  Atlanta , GA 30303
  Phone: 1- 800 - 227-2345
  Web Address: http://www.cancer.org
  

• The Leukemia & Lymphoma Society Inc.
  1311 Mamaroneck Avenue
  White Plains , NY 10605
  Phone: 1- 914 - 949-5213
  Phone: 1- 800 - 955-4572
  Web Address: http://www.leukemia-lymphoma.org
  

When should I call my caregiver?

Call your caregiver if:

• You have a fever.
  
  
• You think you have an infection, such as a cough, cold, or flu.
  
  
• You have new bruises or bruises that are getting bigger.
  
  
• Your lymph nodes become painful or more swollen.
  
  
• You are losing weight without trying.
  
  
• You have night sweats.
  
  
• You feel depressed.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You have bleeding that does not stop.
  
  
• You have trouble breathing.
  
  
• You have a fast heartbeat or chest pain.
  
  
• You have very bad pain in your abdomen.

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.