Chronic lymphocytic leukemia (CLL)

Definition

Chronic lymphocytic leukemia is cancer of the white blood cells (lymphocytes).

Alternative Names

Causes

Chronic lymphocytic leukemia (CLL) causes a slow increase in the number of B lymphocytes in the bone marrow. The cancerous cells spread from the blood marrow to the blood, and can also affect the lymph nodes and other organs. CLL causes the bone marrow to fail and weakens the immune system.

The reason for this increase in B lymphocytes is unknown. There is no link to radiation, cancer-causing chemicals, or viruses.

Usually, the symptoms develop gradually. Many cases are detected by routine blood tests in people with no symptoms.

CLL primarily strikes adults. The average age of a patient with this type of leukemia is 70. It is rarely seen in people younger than 40. The disease is more common in Jewish people of Russian or East European descent, and is uncommon in Asia.

Symptoms

• Enlarged lymph nodes, liver, or spleen
• Fatigue
• Abnormal bruising (occurs late in the disease)
• Excessive sweating, night sweats
• Loss of appetite
• Unintentional weight loss

Exams and Tests

Patients with CLL have a higher-than-normal white blood cell count.

Tests to diagnose CLL include:

• CBC
• Flow cytometry
• Bone marrow aspiration
• Serum protein electrophoresis

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

There are different ways to stage CLL. One system uses numbers to group CLL into low-, intermediate-, and high-risk categories. Generally, the higher the stage number, the more advanced the cancer. Another system uses letters to stage CLL according to how many lymph node groups are affected and whether or not you have a drop in red blood cells and platelets.

Treatment

Early stage disease often requires no specific treatment, but it is important to be closely monitored by your doctor.

Chemotherapy may be needed if fatigue, anemia, thrombocytopenia, or lymph node swelling occurs. Several chemotherapy drugs are commonly used to treat CLL. A common drug used is chlorambucil (Leukeran). Fludarabine and cyclophosphamide (Cytoxan) may also be used.

Rituximab (Rituxan), may also be used alone or in combination with traditional chemotherapy. Alemtuzumab (Campath) is approved for treatment of patients with CLL that have not responded to fludarabine.

Rarely, radiation may be used for enlarged lymph nodes. Blood transfusions or platelet transfusions may be required. Stem cell transplantation may be used in advances stages of CLL.

Support Groups

The stress of illness may be eased by joining a support group whose members share common experiences and problems.

Outlook (Prognosis)

The outlook depends on the stage of the disease. Half of patients diagnosed in the earliest stages of the disease live more than 12 years. Several new tests that look at cell and genetic changes can help predict life expectancy.

Possible Complications

• Hypogammaglobulinemia (reduced levels of antibodies) -- increases the risk of infection
• Other cancer
• Side effects of chemotherapy
• Bleeding from low platelets
• Fatigue from anemia
• Autoimmune hemolytic anemia
• Idiopathic thrombocytopenic purpura (ITP)

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.

American Cancer Society. Cancer Facts and Figures 2006. Atlanta, Ga: American Cancer Society; 2006.

Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004:2921-2940.