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Overview
Leukemia (a cancer of white blood cells) is a broad term used for a group of diseases that starts in tissues such as the bone marrow with a large number of abnormal (cancerous, also called leukemic) blood cells produced and released in the blood of the patients.
Chronic lymphocytic leukemia (also abbreviated as CLL) is one of four types of leukemia and is the second most common type of leukemia diagnosed in adults. It often occurs during or after middle age. CLL starts with a change to a single white blood cell that helps fight infection, called a lymphocyte. Over time, the CLL cells multiply and replace normal lymphocytes in the patient’s marrow and lymph nodes. A high number of CLL cells present in the marrow may ultimately crowd out the other normal blood-forming cells. As a result, because the CLL cells do not fight infection like normal lymphocytes, infection and anemia may occur more frequently in these patients.
Symptoms
CLL symptoms usually develop slowly in a patient. Some patients may have no signs or symptoms in the early stage of their disease and little or no change in their health for many years. Patients may learn they have CLL during a routine health check-up after a blood test shows high levels of white blood cells in their blood sample.
Some common CLL symptoms include:
- Painless swelling of the lymph nodes in the neck, underarm, stomach, or groin (as CLL cells multiply they may pile up in these areas)
- Fatigue (less energy with fewer healthy red oxygenated blood cells and more CLL cells)
- Shortness of breath
- Fever (caused by infection due to a depressed immune system); night sweats
- Infection (more frequent or more severe than usual)
- Sudden weight loss or loss of appetite
Note: these symptoms of CLL are common to other illnesses, so please consult a doctor if you notice any of these signs or symptoms to confirm the actual diagnosis.
Risk factors (i.e., increased chance of getting a disease) for CLL occurring in a patient include:
- The age, gender and race of the patient (middle-aged or older, male, or white are considered risk factors for the disease to occur in a patient)
- A family history of CLL
- The patient being a relative of a Russian or Eastern European Jewish family
Diagnosis
If your doctor suspects you may have developed CLL, he/she may perform the following tests to examine your blood, bone marrow, and lymph nodes. These tests are commonly used to diagnose your disease:
- Physical examination. During a routine examination/check-up, your doctor will check for signs and symptoms of the disease, such as the ones noted above, lumps or anything else that seems unusual.
- Medical history. The doctor will ask for information about your past illnesses and treatments, as well as your general health habits. The doctor may also ask for information about your family’s medical history.
- Complete blood count (CBC). A sample of blood is drawn and checked for the following:
- 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
- Cytogenetic analysis. A test in which cells are viewed under a microscope to look for changes in their structure or their number of chromosomes.
- Immunophenotyping. A test in which cells are viewed under a microscope to find out if malignant (cancer) cells were originated from the B or the T cells in the patient’s immune system. Cancer originating from B cells (also called B-CLL) is the more common disease observed in patients.
- Bone marrow aspiration and biopsy. The removal of bone marrow, blood, or a small piece of bone by inserting a hollow needle into the hipbone or breastbone. An aspiration removes a small amount of fluid from the marrow that the doctor looks at under a microscope to see if there are any changes to the healthy cells. A biopsy removes a very small amount of bone filled with marrow cells, which is then examined under the microscope to provide information about how many cancerous cells are present in the patient’s marrow.
Determining Treatment Options
After confirmation of a diagnosis of CLL, each patient should speak to his or her doctor about the disease and its treatment. A patient with CLL is usually treated by a doctor called a hematologist or an oncologist. It is important to get treatment for CLL in a center where doctors are experienced in the care of these types of patients. There is currently no cure for CLL. Treatment goals are aimed at slowing the growth of CLL cells in the patient’s blood and organs, at keeping the patients feeling well enough to carry on their day-to-day activities, and at protecting patients from more frequent or more severe infections.
Different treatment options for CLL depend on:
- The stage of the disease. Staging is usually based on (1) the size of the cancer, (2) whether the patient’s lymph nodes contain cancer cells, and (3) if the cancer has spread to other organs.
- Red blood cell, white blood cell, and platelet blood counts.
- Signs and symptoms of the disease, such as fever, chills, or weight loss.
- Whether the liver, spleen, or lymph nodes are larger than normal.
- Response to other treatments.
- Whether the cancer has returned despite treatment.
Ultimately, when your doctor decides to treat your CLL, he or she hopes that the treatment will kill as many cancer cells as possible so that healthy, normal cells can grow back in your bone marrow, blood, and lymph systems. The goal of the treatment administered to you is also to make you feel better and to produce a symptom-free period (also called remission of your disease).
Treatment Options
There are many treatment options for patients with CLL. These include:
- Watch and wait—where a doctor closely monitors a patient’s condition without giving him or her any treatment. The results of exams and laboratory tests over time will help to determine when and what type of treatment the patient should receive. During this time, problems caused by the disease, such as infection, are treated with standard of care treatment and/or other procedures.
- Chemotherapy—uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
- Radiation therapy—uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
- Monoclonal antibody therapy—a treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances present on cancer cells or normal substances in the body that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, and/or keep them from spreading. Monoclonal antibodies are given by injection into a vein. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
- Surgery to remove the spleen (splenectomy)—is used for a very small number of CLL patients.
Biogen Idec Investigational Treatments
- Clinical trials—using investigational treatments may be discussed as a possible treatment option for some patients, depending on the specific requirements of the different trials and the patient’s cancer stage and disease status. Click here to learn more about clinical trials. About Clinical Trials
Please contact Biogen Idec directly using the link below for current clinical trials in this disease.
To contact Biogen, click here.
Chronic Lymphocytic Leukemia Resources
http://www.cancer.gov/cancerinfo/pdq/treatment/CLL/patient/
http://www.clltopics.org/index.php
http://www.leukemia-lymphoma.org/all_page?item_id=7059
http://www.centerwatch.com/patient/studies/cat745.html
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