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Home > Healthcare Professionals > Therapeutic Focus > Oncology > Chronic Lymphocyctic Leukemia

Chronic Lymphocytic Leukemia

What is leukemia?

Leukemia is a cancer that begins in the soft, inner part of the bones (bone marrow), and in most cases moves into the blood. It can spread to other parts of the body including the lymph nodes, liver, spleen, central nervous system and testes. “Chronic leukemia” refers to the slow progression of the disease, which when combined with little or no symptoms can cause the leukemia to go undetected until the advanced stages of the disease.

What is chronic lymphocytic leukemia (CLL)?

Chronic lymphocytic leukemia (CLL) is one of four main types of leukemia. CLL begins with a change to a single white blood cell, or lymphocyte, of the bone marrow. Over time, the CLL cells multiply, replacing normal lymphocytes in the marrow and lymph nodes. As the amount of lymphocytes increases in the blood and bone marrow, there is less room for healthy white and red blood cells as well as platelets, which may result in infection, anemia and bleeding. 

What are the risk factors for leukemia and CLL?

Chronic lymphocytic leukemia (CLL) has few known risk factors. There are no known lifestyle-related risk factors and very few environmental factors that have been linked to CLL. Some studies suggest a relationship to herbicides and insecticides. The only known inherited risk factors for CLL are having first-degree relatives (parents, siblings or children) who have had CLL or being of Russian or Eastern European Jewish descent. Being middle-aged or older, male, or white is also a risk factor.

What are the signs and symptoms of CLL?

Usually CLL does not cause any symptoms in patients and is discovered during a routine blood test. In some cases, a person may notice an enlarged lymph node in the neck, armpit or groin and go to the doctor for a checkup. Symptoms that are directly caused by CLL include:

• Painless swelling of the lymph nodes in the neck, underarm, stomach or groin
• Fatigue
• Pain or fullness below the ribs
• Fever and infection
• Weight loss 

How many people are affected by CLL?

More people are living with CLL than any other type of leukemia. The American Cancer Society estimates that about 15,490 new cases of CLL were diagnosed in the United States in 2009. 

Who is affected by CLL?

CLL mainly affects older adults who are on average, approximately 70 years old at the time of diagnosis. It is rarely seen in people under the age of 40 and is more common in men than in women.

How does a physician determine how to treat CLL?

A physical examination is needed to check for signs of disease while various tests that examine the blood, bone marrow and lymph nodes are used to detect and diagnose CLL. From there, the physician and patient will decide on a course of treatment dependent on:

• The stage of the disease
• Red blood cell, white blood cell and platelet blood counts
• Whether there are symptoms, such as fever, chills or weight loss
• Whether the liver, spleen or lymph nodes are larger than usual
• The response to initial treatment
• Whether there has been a recurrence of CLL

What treatment options are currently available for CLL patients?

Early-stage disease often requires no specific treatment, but close observation is important. There are several new investigational therapies being studied in clinical trials. The following are treatment approaches currently used to treat patients with CLL:

• Watchful Waiting – monitoring a patient’s condition without treatment until symptoms appear or change.
• Chemotherapy- these drugs, which are intended to kill cancer cells, enter the bloodstream and reach all areas of the body. This treatment method is particularly useful for cancers such as leukemia that spread throughout the body. Treatment for leukemia often involves a combination of several drugs given over a period of time.
• Monoclonal Antibodies (MAb)- lab-created substances which are similar to the antibodies naturally produced by immune system cells to fight infections. MAb’s are designed specifically to react with certain types of cancer cells, helping the patient’s immune system react and destroy the cells.
• Radiation therapy - a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. This therapy is not usually part of the main treatment for people will CLL, but may be used on patients with an enlarged organ such as the spleen, to shrink the swelling. It may also be used to treat bone pain caused by the overabundance of leukemia cells developing in the bone marrow.