Chronic Lymphocytic Leukemia

Definition

Chronic Lymphocytic Leukemia is a malignancy (cancer) of excessive lymphocyte (a type of white blood cell) production.

Description

Your bone marrow is the spongy tissue inside the large bones in your body. The bone marrow makes red blood cells (which carry oxygen and other materials to all tissues of the body), white blood cells (which fight infection), and platelets (which make your blood clot). Lymphocytes are one type of white blood cell.

Normally, bone marrow cells called blasts develop (mature) into several different types of blood cells that have specific jobs to do in the body.

The lymph system is made up of thin tubes that branch, like blood vessels, into all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid that contains lymphocytes. Along the network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in the underarm, pelvis, neck and abdomen.

The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils (an organ in your throat) are also part of lymph system.

Lymphocytes fight infection by making substances called antibodies, which attack germs in your body. In chronic lymphocytic leukemia (CLL), the developing lymphocytes are overproduced and do not mature correctly. The lymphocytes may look normal, but they cannot fight infection as well as they should.

These immature lymphocytes are found in the blood and the bone marrow. They also collect in the lymph tissues and make them swell. Lymphocytes may crowd out other blood cells in the blood and bone marrow. If your bone marrow cannot make enough red blood cells to carry oxygen, you may have anemia. If your bone marrow cannot make enough platelets to make your blood clot normally, you may bleed or bruise easily.

Leukemia can be acute (progressing quickly with many immature cells) or chronic (progressing slowly with more mature, normal-looking cells). Chronic lymphocytic leukemia progresses slowly and usually occurs in people 60 years of age or older.

Causes and Risk Factors

The cause of this condition is not known.

Symptoms

In the first stages of the disease, there are often no symptoms. As time goes on, more and more lymphocytes are made and symptoms begin to appear. You should see a doctor if your lymph nodes swell, your spleen or liver become larger than normal, you feel tired all the time, or you bleed easily.

Diagnosis

After a complete medical history and physical examination, your doctor may order blood tests to count the number of each of the different kind of blood cells. If the results of the blood test are not normal, you may have more blood tests.

Your doctor also may do a bone marrow biopsy. During this test, a needle is inserted into a bone and a small amount of bone marrow is taken out and looked at under the microscope. Your doctor can then tell what kind of leukemia you have and recommend treatment options.

Your chance of recovery (prognosis) depends on the stage of your disease, your age, and your general health.

Stages Of CLL

Once CLL has been found, more tests may be done to find out if leukemia cells have spread to other parts of the body. This is called staging. Your doctor needs to know the stage of your disease to plan treatment. The following stages are used for CLL:

Stage 0. There are too many lymphocytes in the blood, but there are usually no other symptoms of leukemia. Lymph nodes and the spleen and liver are not swollen and the number of red blood cells and platelets is normal.

Stage I. There are too many lymphocytes in the blood and lymph nodes are swollen. The spleen and liver are not swollen and the number of blood cells and platelets is normal.

Stage II. There are too many lymphocytes in the blood and lymph nodes and the liver and spleen are swollen.

Stage III. There are too many lymphocytes in the blood and there are too few red blood cells (anemia). Lymph nodes and the liver or spleen may be swollen.

Stage IV. There are too many lymphocytes in the blood and too few platelets, which may it hard for the blood to clot. The lymph nodes, liver, or spleen may be swollen and there may be too few red blood cells (anemia).

Treatment

Treatment may include:

1. Chemotherapy (using drugs to kill cancer cells) is most commonly used.

2. Radiation therapy (using high-dose x-rays or other high energy rays to kill cancer cells)

3. Biological therapy (using your body's immune system to fight cancer)

4. Surgery may be used in certain cases

Chemotherapy uses drugs to kill cancer cells and is used most often. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

Radiation Therapy uses x-rays for other high-energy rays to kill cancer cells and shrink tumors. Radiation for CLL usually comes from a machine outside the body (external radiation therapy).

Biological Therapy tries to get your own body to fight cancer. It uses materials made by your own body or made in a laboratory to boost, direct, or restore your body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

If your spleen is swollen, your doctor may take out the spleen in an operation called splenectomy. This is only done in rare cases.

Because infection often occurs in patients with CLL, a special substance called immunoglobulin, which contains antibodies, may be given to prevent infections.

Sometimes a special machine is used to filter the blood to take out extra lymphocytes. This is called leukapheresis.

The rare young patient with aggressive CLL may be a candidate for bone marrow transplantation.

Questions to Ask Your Doctor

What stage of CLL do I have?

What treatment do you recommend?

What medications are necessary?

What are the side-effects?

What is the prognosis?