Chronic Lymphocytic Leukemia (CLL)

CLL can also be associated with the presence of chronic lymphocytic lymphoma (small cell non-Hodgkins lymphoma , a less aggressive form of lymphoma) because the abnormal cells in each case may come from the same parent cell source. As a result, one of the signs of CLL may be a swelling in the lymph nodes. CausesThe exact cause of CLL is unknown, but changes in chromosomes (genetic material) that occur during life have been associated with CLL. It is also associated with exposure to radiation and to toxic chemicals, such as benzene (common in agriculture, paint manufacture, and dye manufacture) and Agent Orange (an herbicide used in the Vietnam war). Risk FactorsA risk factor is something that increases your chance of getting a disease or condition. The following factors increase your chance of developing CLL: Age: Middle age or olderSex: MaleRace: WhiteA family history of CLL or cancer of the lymphatic systemHaving relatives who are Russian Jews or Eastern European JewsExposure to Agent Orange SymptomsSymptoms include:Painless swelling in the neck, underarms, stomach, or groinTiredness Paleness (a sign of anemia ) Pain or a feeling of fullness below the ribsFeverInfectionUnexplained weight lossReduced exercise toleranceBone painEnlargement of liver and spleen DiagnosisYour doctor will ask about your symptoms and medical history and perform a physical exam. He or she may also check for swelling of the liver; spleen, or lymph nodes in the armpits, groin, or neck. You will likely be referred to an oncologist, a doctor who specializes in treating cancer.

Tests may include the following: Blood teststo check for changes in the number or appearance of different types of blood cellsBone marrow aspirationremoval of a sample of liquid bone marrow to test for cancer cellsBone marrow biopsy removal of a sample of liquid bone marrow and a small piece of bone to test for cancer cells Spinal tap removal of a small amount of cerebrospinal fluid to check for cancer cells Routine microscopic examexamination of a sample of blood, bone marrow, lymph node tissue, or cerebrospinal fluidBone, blood marrow, lymph node tissue, or cerebrospinal fluid teststo distinguish among types of leukemia and to determine whether there are leukemic cells in the lymph nodes or spinal fluidCytogenetic analysisa test to look for certain changes of the chromosomes (genetic material) of the lymphocytes; this is used in part to make a specific diagnosis of type, but may also be used to help plan treatment.Chest x-ray x-rays of the chest that may detect signs of lung infection or cancer in the chest CT scan a type of x-ray that uses a computer to make pictures of structures inside the body MRI scan a test that uses magnetic waves to make pictures of structures inside the body Gallium scan and bone scaninjection of a radioactive chemical into the bloodstream to detect areas of cancer or infectionUltrasound a test that uses sound waves to examine masses and organs inside the body TreatmentTalk with your doctor about the best treatment plan for you. Treatment options include:

Watchful WaitingIn watchful waiting, a doctor monitors the progress of the disease without treating it until symptoms appear to change and become bothersome. During this time, other problems, including infection, can be treated. Watchful waiting is often used in low-risk CLL. Some patients may go for many years before more aggressive treatment is needed. Radiation TherapyRadiation therapy involves the use of radiation to kill cancer cells and shrink tumors. The type of radiation used for CLL is known as external radiation therapy. In external radiation therapy, radiation is directed at the tumor from a source outside the body. This treatment is used to treat the brain and spinal cord when indicated, and also to treat lymph node involvement. ChemotherapyChemotherapy is the use of drugs to kill cancer cells. It may be given in many forms, including pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body killing mostly cancer cells, but also some healthy cells. Surgery A splenectomy , which is surgery to remove the spleen, may be performed. Monoclonal Antibody TherapyMonoclonal antibody therapy uses antibodies made in a laboratory to identify substances on cancer cells or substances on normal cells that may help cancer grow. The antibodies attach to these substances, killing the cancer cells, blocking their growth, or preventing them from spreading.

Chemotherapy With Stem Cell TransplantChemotherapy with stem cell transplant as a treatment for CLL is still being tested in clinical trials. In this treatment, chemotherapy is followed by a transplantation of stem cells (immature blood cells) to replace blood-forming cells destroyed by cancer treatment. Stem cells are removed from the blood or bone marrow of the patient or donor, and infused into the patient. Treatment of Side EffectsPatients will suffer side effects not only from the leukemia, but from therapy. These include a reduction in red blood cells (anemia), reduced numbers of platelets that assist in blood clotting (thrombocytopenia), and decreased numbers of the white blood cells that fight infection.Anemia may lead to fatigue or, if severe enough, can complicate respiratory or cardiac disease. Thrombocytopenia may lead to bleeding and bruising. Decreased numbers of white blood cells leave a patient more vulnerable to infection.Your physician may prescribe a number of different treatments to alleviate these side effects. Drugs are available to increase production of normal blood cells. In addition, when counts are particularly low, your doctor may recommend blood transfusions, or modification of your daily activities to reduce the chance of fatigue, bleeding, or infection.

PreventionThere are no guidelines for preventing CLL. RESOURCES: American Cancer Societyhttp://www.cancer.org The Leukemia and Lymphoma Societyhttp://www.leukemia-lymphoma.org/hm_lls National Cancer Institutehttp://www.cancer.gov CANADIAN RESOURCES BC Cancer Agencyhttp://www.bccancer.bc.ca/default.htm Canadian Cancer Societyhttp://www.cancer.ca References: Chronic lymphocytic leukemia (PDQ): treatment. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/CLL/Patient/ . Accessed November 26, 2005. Detailed guide: leukemiachronic lymphocytic. American Cancer Society website. Available at: http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?rnav=cridg&dt=62 . Accessed November 26, 2005. Last reviewed January 2008 by Igor Puzanov, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.