Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia (CLL) is a type of cancer of the bone marrow and blood cells. Bone marrow is the soft, spongy tissue inside your bone. In CLL, the bone marrow makes too many white blood cells that usually fight infection in the body (lymphocytes). CLL usually gets worse slowly and is the most common type of adult leukemia.

RISK FACTORS

No one knows the exact cause of CLL. There is a higher risk of CLL in people who:

  • Are older than 50 years.

  • Are white.

  • Are male.

  • Have a family history of CLL or other cancers of the lymph system.

  • Are of Russian Jewish or Eastern European Jewish descent.

  • Have been exposed to certain chemicals, such as Agent Orange (used in the Vietnam War) or other herbicides or insecticides.

SYMPTOMS

At first, there may be no symptoms of chronic lymphocytic leukemia. After a while, some symptoms may occur, such as:

  • Feeling more tired than usual, even after rest.

  • Unplanned weight loss.

  • Heavy sweating at night.

  • Fevers.

  • Shortness of breath.

  • Decreased energy.

  • Paleness.

  • Painless, swollen lymph nodes.

  • A feeling of fullness in the upper left part of the abdomen.

  • Easy bruising or bleeding.

  • More frequent infections.

DIAGNOSIS

Your health care provider may perform the following exams and tests to diagnose CLL:

  • Physical exam to check for an enlarged spleen, liver, or lymph nodes.

  • Blood and bone marrow tests to identify the presence of cancer cells. These may include tests such as complete blood count, flow cytometry, immunophenotyping, and fluorescence in situ hybridization (FISH).

  • CT scan to look for swelling or abnormalities in your spleen, liver, and lymph nodes.

TREATMENT

Treatment options for CLL depend on the stage and the presence of symptoms. There are a number of types of treatment used for this condition, including:

  • Observation.

  • Targeted drugs. These are drugs that interfere with chemicals that leukemia cells need in order to grow and multiply. They identify and attack specific cancer cells without harming normal cells.

  • Chemotherapy drugs. These medicines kill cells that are multiplying quickly, such as leukemia cells.

  • Radiation.

  • Surgery to remove the spleen.

  • Biological therapy. This treatment boosts the ability of your own immune system to fight the leukemia cells.

  • Bone marrow or peripheral blood stem cell transplant. This treatment allows the patient to receive very high doses of chemotherapy and/or radiation. These high doses kill the cancer cells but also destroy the bone marrow. After treatment is complete, you are given donor bone marrow or stem cells, which will replace the bone marrow.

HOME CARE INSTRUCTIONS

  • Because you have an increased risk of infection, practice good hand washing and avoid being around people who are ill or being in crowded places.

  • Because you have an increased risk of bleeding and bruising, avoid contact sports or other rough activities.

  • Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your health care provider.

  • Although some of your treatments might affect your appetite, try to eat regular, healthy meals.

  • If you develop any side effects, such as nausea, diarrhea, rash, white patches in your mouth, a sore throat, difficulty swallowing, or severe fatigue, tell your health care provider. He or she may have recommendations of things you can do to improve symptoms.

  • Consider learning some ways to cope with the stress of having a chronic illness, such as yoga, meditation, or participating in a support group.

SEEK MEDICAL CARE IF:

  • You develop chest pains.

  • You notice pain, swelling or redness anywhere in your legs.

  • You have pain in your belly (abdomen).

  • You develop new bruises that are getting bigger.

  • You have painful or more swollen lymph nodes.

  • You develop bleeding from your gums, nose, or in your urine or stools.

  • You are unable to stop throwing up (vomiting).

  • You cannot keep liquids down.

  • You feel lightheaded.

  • You have a fever or persistent symptoms for more than 2–3 days.

  • You develop a severe stiff neck or headache.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have trouble breathing or feel short of breath.

  • You faint.