Chronic Lymphocytic Leukemia

What is chronic lymphocytic leukemia?

Chronic lymphocytic leukemia (CLL) is a cancer of the blood and bone marrow. It affects a type of white blood cells called lymphocytes. The cancer causes large numbers of abnormal white cells to form, crowding out normal blood cells.

How does it occur?

The cancer starts in the bone marrow. Marrow is the soft, fatty tissue inside the hard, outer part of the bones. The marrow makes blood stem cells, which become the different types of blood cells, including white blood cells, red blood cells, and platelets.

Normally, lymphocytes help your body fight infection and other diseases. Chronic lymphocytic leukemia happens when the body makes too many abnormal lymphocytes. The abnormal cells crowd out other, normal blood cells needed by the body. They do not die, like normal lymphocytes. Instead, they are long-lived and accumulate. The abnormal lymphocytes cannot fight infections like normal white blood cells. So, it’s easier for you to get infections. In addition, you become anemic because you don’t have enough red blood cells. The number of platelets also decreases. This causes you to have blood clotting problems and to bleed easily.

The cause of the disease is not known. Most people who have CLL are over age 60, and it is more common in men than women. It is also more common in people who have close family members who have had CLL.

What are the symptoms?

CLL most often has no or few symptoms. In some people, the first signs of the disease are:

• painless swelling of the lymph nodes in the neck, underarm, stomach, or groin
• feeling unusually tired
• an infection that does not go away, or frequent infections
• unexpected weight loss.
• loss of appetite
• sweats and fever.

How is it diagnosed?

Healthcare provider usually discover the disease during a routine blood test. The blood test will show an abnormally high white blood cell count. You may have other tests to help diagnose and classify the leukemia, such as a biopsy to look at samples of your bone marrow. For the biopsy, a needle is used to get samples of marrow, usually from the back pelvic bone.

How is it treated?

In the early stage of CLL, when you have no signs or symptoms, you will not need treatment. There is no cure for the disease, so treatment focuses on controlling the symptoms. When your lymph nodes, spleen, or liver get bigger or when the disease gets worse and you have symptoms, you need to be treated. Your healthcare provider will want to check you regularly. You may need to see a cancer specialist called an oncologist/hematologist.

When you need treatment, your cancer specialist will prescribe chemotherapy.

• Chemotherapy, either by mouth or by vein, uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing.
• Steroid medicine may help control the growth of CLL cells.
• Monoclonal antibodies are artificial proteins. Your provider can put them into your bloodstream to help the body's immune system destroy leukemic cells.

How long will the effects last?

The disease may slowly get worse over many years. How long you will live after diagnosis depends on the stage of the disease when it was diagnosed and how fast the cancerous cells are growing. Many people with CLL live normal lives for many years.

How can I take care of myself?

• Make sure that you have regular checkups and follow your provider's advice for taking care of yourself. Discuss questions and concerns with your provider.
• Know your medicines and take them exactly as your provider tells you to. Know what they look like, how much you are to take each time, how often you are to take them, and why you take each one.
• Check with your healthcare provider before taking other medicines, including nonprescription products or other forms of treatment. Carry a list of your medicines in your wallet or purse. Include any nonprescription medicines and supplements on the list.
• Eat a healthy diet and be as active as is comfortable and recommended. Ask your provider if you need to avoid some activities or be careful about what you eat. Get plenty of rest.
• Take precautions during your treatment to avoid infections. Try to stay away from crowds and people who may be sick. Avoid small children, especially children who attend day care (they often have colds and other infections). When you are around people, including family, wash your hands often. Do not share towels. Ask your provider if you should wear a surgical mask when you are out in public so that you are less likely to breathe in germs.
• If you lose your appetite and begin to lose weight, ask your provider about medicine that can help you have a better appetite.
• Do not smoke.
• Ask your provider if you need to avoid drinking alcohol. It may interfere with medicines you are taking. Alcohol can also make it harder for white blood cells to fight infections.
• Make sure you get a pneumonia shot and yearly flu shots.
• Learn about your illness. Join a support group to learn from other cancer survivors and to share what has helped you.
• Tell your healthcare provider if you have new or worsening:
  • tiredness
  • weakness
  • fever
  • sore throat
  • easy bruising or bleeding
  • loss of appetite
  • weight loss
  • bone pain
  • feeling of fullness below the ribs, especially on the left
  • swollen lymph nodes in the neck, underarms, and groin
  • sweating at night
  • infections

For more information, contact the Leukemia and Lymphoma Society at 800-955-4572 or visit their Web site at http://www.leukemia.org.

How can I help prevent chronic lymphocytic leukemia?

Because healthcare providers do not know what causes CLL and no risk factors have been found, they do not know how to prevent it.