Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia (CLL) is a form of cancer in which the bone marrow makes too many lymphocytes. In most cases, CLL progresses slowly. The disease most often develops after middle age; this type of leukemia rarely affects children. Possible signs of chronic lymphocytic leukemia include swollen lymph nodes and tiredness. Treatment options for CLL can include radiation therapy, chemotherapy, and surgery.

CLL
 

What Is Chronic Lymphocytic Leukemia?

Chronic lymphocytic leukemia (CLL) is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell). Also known as chronic lymphoblastic leukemia, chronic lymphocytic leukemia is the second most common type of leukemia seen in adults, accounting for about 7,000 new cases of leukemia each year. The American Cancer Society estimated that 10,020 Americans (6,280 men and 3,740 women) would be diagnosed with chronic lymphocytic leukemia in 2006. Chronic lymphocytic leukemia often occurs during or after middle age; it rarely occurs in children. CLL usually progresses slowly.
 
(Click Types of Leukemia to learn about other leukemia types.)
 

Chronic Lymphocytic Leukemia and Blood Cells

Normally, the body produces bone marrow stem cells (immature cells) that develop into mature blood cells. The three types of mature blood cells include:
 
  • Red blood cells that carry oxygen and other materials to all tissues of the body
  • White blood cells that fight infection and disease
  • Platelets that help prevent bleeding by causing blood clots to form.
 
In chronic lymphocytic leukemia, too many stem cells develop into a type of white blood cell called lymphocytes. The three types of lymphocytes include:
 
  • B lymphocytes that make antibodies to help fight infection
  • T lymphocytes that help B lymphocytes make antibodies to fight infection
  • Natural killer cells that attack cancer cells and viruses.
 
In chronic lymphocytic leukemia, the lymphocytes are not able to fight infection very well, and as the amount of lymphocytes increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may result in infection, anemia, and easy bleeding.
 

Risk Factors for Chronic Lymphocytic Leukemia

No one knows the exact causes of chronic lymphocytic leukemia, and doctors can seldom explain why one person will get CLL and another person will not. However, leukemia research has shown that people with certain risk factors are more likely than others to develop chronic lymphocytic leukemia. A risk factor is anything that increases a person's chances of developing a disease.
 
Risk factors for chronic lymphocytic leukemia include:
 
  • Being middle-aged or older, male, or Caucasian
  • A family history of chronic lymphocytic leukemia or cancer of the lymph system
  • Having relatives who are Russian Jews or Eastern European Jews.
 

Symptoms of Chronic Lymphocytic Leukemia

Like all blood cells, leukemia cells travel through the body. Depending on the number of abnormal cells and where these cells collect, patients with chronic lymphocytic leukemia may have a number of CLL symptoms.
 
(Click CLL Symptoms for more information about symptoms of chronic lymphocytic leukemia.)
 

Diagnosing Chronic Lymphocytic Leukemia

Tests that examine the blood, bone marrow, and lymph nodes are used to detect and diagnose chronic lymphocytic leukemia.
 
Tests and procedures that may be used to diagnose CLL include:
 
  • Physical exam (along with a review of the patient's medical history)
  • Complete blood count
  • Cytogenetic analysis
  • Immunophenotyping
  • Bone marrow aspiration and biopsy.
 
Physical Exam and Medical History
A physical exam entails an exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. The healthcare provider will also take and review a history of the patient's health habits and past illnesses and treatments.
 
Complete Blood Count (CBC)
A complete blood count is a procedure in which a sample of blood is drawn and checked for:
 
  • The number of red blood cells, white blood cells, and platelets
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells
  • The portion of the blood sample made up of red blood cells.
 
Cytogenetic Analysis
A cytogenetic analysis is a test in which cells in a sample of blood or bone marrow are viewed under a microscope to look for changes in the structure or number of chromosomes in the lymphocytes.
 
Immunophenotyping
Immunophenotyping is a test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant lymphocytes (cancer) began from the B lymphocytes or the T lymphocytes.
 
Bone Marrow Aspiration and Biopsy
A bone marrow aspiration and biopsy involves the removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist will then view both the bone and bone marrow samples under a microscope to look for abnormal cells.
 

Chronic Lymphocytic Leukemia: Stages of CLL

After the doctor makes a chronic lymphocytic leukemia diagnosis, it's then necessary to determine how far the cancer has spread in the blood and bone marrow. This process is known as staging. It is important to know the stage of CLL in order to plan the best chronic lymphocytic leukemia treatment.
 
The stages of CLL include:
 
  • Stage 0
  • Stage I
  • Stage II
  • Stage III
  • Stage IV
  • Recurrent.
 

Treatment for Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia treatment options will depend on factors such as:
 
  • The chronic lymphocytic leukemia stage (see CLL Treatment by Stage)
  • Red blood cell, white blood cell, and platelet blood counts
  • Whether the liver, spleen, or lymph nodes are larger than normal
  • The response to initial chronic lymphocytic leukemia treatment
  • Whether the chronic lymphocytic leukemia has recurred (come back)
  • Whether there are chronic lymphocytic leukemia symptoms, such as fever, chills, or weight loss.
 
Specific chronic lymphocytic leukemia treatment options include:
 
  • Watchful waiting
  • Radiation therapy
  • Chemotherapy
  • Surgery
  • Monoclonal antibody therapy.
 
Choosing the most appropriate treatment for chronic lymphocytic leukemia is a decision that ideally involves the patient, the family, and the healthcare team.
 

The Prognosis for Chronic Lymphocytic Leukemia

The chronic lymphocytic leukemia prognosis (chance of recovery) will depend on factors such as:
 
  • Whether there is a change in the DNA and the type of change, if there is one
  • Whether lymphocytes are spread throughout the bone marrow
  • The stage of chronic lymphocytic leukemia
  • Whether the chronic lymphocytic leukemia gets better with treatment or has recurred
  • The patient's general health
  • Whether the chronic lymphocytic leukemia progresses to lymphoma or prolymphocytic leukemia.
 

Chronic Lymphocytic Leukemia: Summary

Key information about chronic lymphocytic leukemia includes the following:
 
  • Chronic lymphocytic leukemia (CLL) is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell)
 
  • Examples of risk factors for CLL include having a family history of the disease and being middle-aged or older, male, or Caucasian.
 
  • Possible signs of chronic lymphocytic leukemia include swollen lymph nodes and tiredness
 
  • Tests that examine the blood, bone marrow, and lymph nodes are used to detect and diagnose chronic lymphocytic leukemia
 
  • Factors that affect treatment options and prognosis (chance of recovery) for chronic lymphocytic leukemia include such things as the stage of the cancer and whether the cancer has recurred
 
  • The American Cancer Society estimated that 10,020 Americans (6,280 men and 3,740 women) would be diagnosed with chronic lymphocytic leukemia in 2006.
 
(Click CLL Statistics for more statistics on CLL.)
Add this article to your Favorites     Email this article     Print
Written by/reviewed by: Arthur Schoenstadt, MD
Last reviewed by: Arthur Schoenstadt, MD