Chronic lymphocytic leukemia (CLL)

Alternative names
CLL

Definition
Chronic lymphocytic leukemia is a malignancy (cancer) of the white blood cells (lymphocytes) characterized by a slow, progressive increase of these cells in the blood and the bone marrow.

Causes, incidence, and risk factors

Chronic lymphocytic leukemia (CLL) affects the B lymphocytes and causes immunosuppression, failure of the bone marrow, and invasion of malignant (cancerous) cells into organs.

Usually the symptoms develop gradually. The incidence is about 2 per 100,000 and increases with age (90% of cases are found in people over 50). Many cases are detected by routine blood tests in people with no symptoms. The cause of CLL is unknown. No relationship to radiation, carcinogenic chemicals or viruses has been determined. The disease is more common in Jewish people of Russian or East European descent, and is uncommon in Asia

Symptoms

     
  • Enlarged lymph nodes, liver or spleen  
  • Fatigue  
  • Abnormal bruising (occurs late in the disease)  
  • Excessive sweating, night sweats  
  • Loss of appetite  
  • Unintentional weight loss

Signs and tests

     
  • Elevated white blood cell count in a CBC  
  • Flow cytometry revealing an abnormal population of white blood cells.  
  • Bone marrow aspiration

This disease may also alter the results of serum protein electrophoresis.

Treatment

Since early treatment does not improve survival, early-stage disease often requires no specific treatment, but close observation is important. Chemotherapy may be needed if a patient develops fatigue, anemia, thrombocytopenia, or enlarged lymph nodes that are troublesome.

The anti-cancer medicine (chemotherapy) used first is usually fludarabine. Other medicines that may be used in this disease include chlorambucil (Leukeran) and cyclophosphamide (Cytoxan).

The treatment of CLL is changing rapidly. Recently, several new drugs, including alemtuzumab (Campath) - which is an antibody against the surface of CLL cells - has been approved for treatment of patients with CLL who have failed fludarabine. Another antibody drug, rituximab (Rituxan), may also be used alone or in combination with traditional chemotherapy. Rarely, radiation may be used for enlarged lymph nodes. Blood transfusions or platelet transfusions may be required.

Support Groups
The stress of illness may be eased by joining a support group whose members share common experiences and problems.

Expectations (prognosis)
The prognosis depends on the stage of the disease. Half of patients diagnosed in the earliest stages of the disease live more than 12 years. On the other hand, if CLL has reached an advanced stage, about half of these patients die within 2 years.

Complications

     
  • Increased risk of second malignancies  
  • Side effects of chemotherapy  
  • Bleeding from low platelets  
  • Fatigue from anemia  
  • Autoimmune hemolytic anemia  
  • Idiopathic thrombocytopenic purpura (ITP)  
  • Hypogammaglobulinemia (reduced levels of antibodies) with increased susceptibility to infection

Calling your health care provider
Call health care provider if you develop enlarged lymph nodes or unexplained fatigue, bruising, excessive sweating, or weight loss.

Johns Hopkins patient information

Last revised: December 5, 2012
by David A. Scott, M.D.

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