About Chronic Lymphocytic Leukemia (CLL)
Chronic lymphocytic leukemia (CLL) is a type of cancer that affects the white blood cells in the bone marrow and blood. With CLL, the bone marrow makes too many abnormal white blood cells. These cancerous white blood cells crowd out healthy blood cells, including red blood cells, platelets, and normal white blood cells. CLL can eventually affect various organs, including bone marrow, lymph nodes, spleen, liver, and other tissues.
CLL is the most common form of leukemia in adults, with a higher incidence in individuals aged 65-70 years. However, it can also affect people under 55 years old. It is uncommon in children or young adults. Symptoms may not appear for years after CLL develops, and not all patients require immediate chemotherapy upon diagnosis. It is important to consult with a healthcare professional for an accurate diagnosis and personalized treatment plan.
Chronic Lymphocytic Leukemia (CLL) occurs when chromosomes or genes mutate (change) and triggers the bone marrow to produce abnormal white blood cells. The exact cause of the mutations and development CLL is unknown, but there are certain risk factors that may increase the chances of developing the condition.
Non-modifiable risk factors of CLL (factors that a person cannot change or control):
- Age: CLL is more common in older adults, with the average age of diagnosis being around 70 years old.
- Race: In the U.S., white people are more likely to develop CLL than people of other races.
- Sex: Males assigned at birth are more likely to develop CLL than females assigned at birth.
- Family history: Having a close relative, such as a parent or sibling, with CLL or other blood or bone marrow cancers increases the risk of developing the condition.
- Previous exposure to certain chemicals: Certain herbicides and insecticides are linked to CLL. An example is Agent Orange that was used during the Vietnam War.
- Weakened immune system: People with weakened immune systems, such as those who have undergone an organ transplant or have HIV/AIDS, may have an increased risk of developing CLL.
Modifiable risk factors of CLL:
- Exposure to certain chemicals: Long-term exposure to certain chemicals, such as benzene or herbicides, may increase the risk of developing CLL. However, the link between chemical exposure and CLL is not well-established.
It's important to note that having these risk factors does not guarantee that a person will develop CLL. Conversely, some people without any known risk factors may still develop the condition. If you have concerns about your risk for CLL or any other health condition, it's always best to consult with your healthcare professional for personalized advice.
CLL is a slowly progressive cancer. People may have CLL for years before noticing any symptoms. Common symptoms of CLL) include:
- Enlarged lymph nodes in the neck, underarm, stomach, or groin
- Fever without known reason
- Fatigue
- Easy bruising or bleeding
- Anemia
- Frequent infections
- Night sweats
- Decreased appetite
- Unintentional weight loss
- Enlarged spleen or liver, which may lead to abdominal discomfort or pain in the area under the ribs.
It's important to note that these symptoms are general and can be caused by other conditions as well. If you experience any potential signs or symptoms of CLL, it's advisable to consult with a healthcare professional for an accurate diagnosis and appropriate management.
To diagnose CLL, the following examinations, tests, and procedures may be performed:
- Health history: The healthcare professional will gather information about symptoms, past illnesses, current medical conditions and medications, and family medical history.
- Physical exam: The healthcare professional examines the body to check for signs of disease, such as enlarged lymph nodes, spleen, or liver or anything unusual.
- Blood tests:
- Complete blood count (CBC) with differential: A blood sample is drawn and checked to determine the number and type of white blood cells, red blood cells, platelets, and hemoglobin levels.
- Blood chemistry studies: A blood sample is analyzed to measure the amounts of certain substances released into the blood by organs and tissues in the body.
- Viral testing: A blood sample is checked for hepatitis B, hepatitis C, and HIV
- Peripheral blood smear: A pathologist will analyze a blood sample using a microscope to look for cancerous blood cells.
- Bone marrow biopsy: A sample of bone marrow tissue and fluid is obtained and sent to a pathologist look for signs of leukemia.
To determine the severity of CLL (if it has spread to other parts of the body) and obtain information to help with treatment decisions, additional examinations, tests, and procedures may be recommended:
- Genetic tests: Samples of blood, saliva, or other tissues are used to identify changes in genes, chromosomes, or proteins that may be associated with CLL.
- Imaging studies: X-rays, MRIs, or CT scans may be performed to evaluate if CLL has spread to internal organs.
- Lymph node biopsy: A sample or an entire enlarged lymph node may be removed to determine if leukemia has spread.
- Lumbar puncture: If there is a suspicion that CLL has spread to the central nervous system, a small fluid sample may be taken from the lower spine for analysis.
It's important to follow up with your healthcare provider if any symptoms worsen or change after the physical exam. Discuss these tests and procedures with your healthcare professional for personalized advice.
The goals of treatment for CLL are to slow the growth of leukemia cells and achieve long periods of remission, where signs and symptoms of cancer are reduced or disappear. Here are the different types of treatments and how they work towards these goals. In many cases,a combination of treatments will be used.
- Watchful waiting: In this approach, treatment is not immediately given, and regular monitoring is done to check for any changes in signs or symptoms.
- Chemotherapy: It involves the use of drugs to kill cancer cells. Chemotherapy can be given orally or through injections.
- Targeted therapy: This treatment uses drugs or substances that specifically attack cancer cells while causing less harm to normal cells. Examples of targeted therapies include tyrosine kinase inhibitors (TKIs) and monoclonal antibodies.
- Immunotherapy: This therapy helps boost the body's immune system to fight against cancer cells. It can be done through monoclonal antibodies or other immune-stimulating substances. An example is CAR T-cell therapy.
- Radiation therapy: This treatment uses high-energy beams to destroy cancer cells. It is often used to target specific areas affected by CLL and help ease symptoms.
- Bone marrow or stem cell transplant: This procedure replaces damaged bone marrow with healthy stem cells, allowing the body to produce new, healthy blood cells.
- Supportive therapies: Medications and other therapies may be recommended to manage complications of CLL or its treatment. These may include vaccines, blood transfusions, and medications to prevent infections may be recommended.
Remember, treatment plans should be personalized based on individual circumstances. Consult with your healthcare team for specific recommendations and guidance.