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Chronic Lymphocytic Leukemia

What is leukemia?
Leukemia is cancer of the blood cells, usually the white blood cells.

What are the types of leukemia?
There are four main types of leukemia, which can be further divided into subtypes. When classifying the type of leukemia, the first steps are to determine if the cancer is:

1. Lymphocytic or myelogenous leukemia:
Cancer can occur in either the lymphoid or myeloid white blood cells.

When the cancer develops in the lymphocytes (lymphoid cells), it is called lymphocytic leukemia.

When the cancer develops in the granulocytes or monocytes (myeloid cells), it is called myelogenous leukemia.

2. Acute or chronic leukemia:
Leukemia is either acute or chronic.

Acute leukemia
The new or immature cancer cells, called blasts, remain very immature and cannot perform their functions. The blasts increase in number rapidly, and the disease progresses quickly.

Chronic leukemia
There are some blast cells present, but they are more mature and are able to perform some of their functions. The cells grow more slowly, and the number increases less quickly, so the disease progresses gradually.

Based on these findings, the leukemia is then classified into one of the four main types of leukemias: acute myelogenous leukemia (AML); chronic myelogenous leukemia (CML); acute lymphocytic leukemia (ALL); or chronic lymphocytic leukemia (CLL).

What is chronic lymphocytic leukemia?

Chronic lymphocytic leukemia (CLL) is a cancer of the blood in which too many lymphocytes, a type of white blood cell, are produced by the bone marrow and by organs of the lymph system.

Normally, most lymphocytes fight infection by making antibodies that attack harmful elements. But, in CLL, the cells are immature and overabundant. They crowd out other blood cells, and may collect in the blood, bone marrow, and lymph tissue. CLL is a slowly progressing disease.

According to the American Cancer Society, about 47,000 leukemia cases are expected to be diagnosed in 2012. CLL will account for about 16,000 of these cases.

What are the symptoms of chronic lymphocytic leukemia?

Early in the disease, there may be no noticeable symptoms, and many cases are diagnosed on routine blood tests. The following are the most common symptoms of chronic lymphocytic leukemia. However, each individual may experience symptoms differently. Symptoms may include:

  • Persistent weakness or fatigue
  • Swollen lymph nodes
  • Enlarged spleen, which can cause loss of appetite
  • Enlarged liver
  • Fever
  • Night sweats
  • Weight loss
  • Frequent infections
  • Easy bruising or bleeding

The symptoms of chronic lymphocytic leukemia may resemble other blood disorders or medical problems. Always consult your doctor for a diagnosis.

How is chronic lymphocytic leukemia diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for chronic lymphocytic leukemia may include the following:

  • Bblood tests and other evaluation procedures
  • Bone marrow aspiration and/or biopsy. A procedure that involves taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (called a core biopsy), usually from the hip bones, to be examined for the number, size, and maturity of blood cells and/or abnormal cells.
  • Spinal tap/lumbar puncture. A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord. The test isn't usually needed for CLL unless your doctor suspects a problem in the brain or spinal cord.

Treatment for chronic lymphocytic leukemia

Specific treatment for chronic lymphocytic leukemia will be determined by your doctor based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Other traits of the disease, such as chromosome changes in the leukemia cells
  • Whether or not you are having symptoms
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Treatment may include:

  • Watchful waiting. Close monitoring of the disease and not treating it unless it begins to grow quickly or cause symptoms.
  • Chemotherapy
  • Radiation therapy
  • Monoclonal antibodies, such as Rituxan, Arzerra, or Campath, that provide targeted therapy
  • Treatment for complications, such as infection or anemia
  • Leukapheresis. A procedure to remove excess lymphocytes from the body
  • Bone marrow or peripheral blood stem cell transplantation.
  • Splenectomy. Surgery to remove the spleen.

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