Chronic Lymphocytic Leukemia
Table of Contents
What is chronic lymphocytic leukemia?
- Stage Explanation
-
Stages of chronic lymphocytic leukemia
- Stage 0
- Stage I
- Stage II
- Stage III
- Stage IV
-
- Refractory
- Treatment Option Overview
-
How chronic lymphocytic leukemia is treated
- Treatment by stage
- Stage 0 Chronic Lymphocytic Leukemia
- Stage I Chronic Lymphocytic Leukemia
- Stage II Chronic Lymphocytic Leukemia
- Stage III Chronic Lymphocytic Leukemia
- Stage IV Chronic Lymphocytic Leukemia
- Refractory Chronic Lymphocytic Leukemia
-
- To Learn More
What is chronic lymphocytic leukemia?
Chronic lymphocytic leukemia (CLL) is a disease in which too many infection-fighting
white blood cells called lymphocytes are found in the body. Lymphocytes are made in the
bone marrow and by other organs of the lymph system. The bone marrow is the spongy tissue
inside the large bones in the body. The bone marrow makes red blood cells (which carry
oxygen and other materials to all tissues of the body), white blood cells (which fight
infection), and platelets (which make the blood clot). Normally, bone marrow cells called
blasts develop (mature) into several different types of blood cells that have specific
jobs to do in the body.
The lymph system is made up of thin tubes that branch, like blood vessels, into all
parts of the body. Lymph vessels carry lymph, a colorless, watery fluid that contains
lymphocytes. Along the network of vessels are groups of small, bean-shaped organs called
lymph nodes. Clusters of lymph nodes are found in the underarm, pelvis, neck, and abdomen.
The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood
cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils
(an organ in the throat) are also part of the lymph system.
Lymphocytes fight infection by making substances called antibodies, which attack germs
and other harmful things in the body. In CLL, the developing lymphocytes do not mature
correctly and too many are made. The lymphocytes may look normal, but they cannot fight
infection as well as they should. These immature lymphocytes are then found in the blood
and the bone marrow. They also collect in the lymph tissues and make them swell.
Lymphocytes may crowd out other blood cells in the blood and bone marrow. Anemia may
develop if the bone marrow cannot make enough red blood cells to carry oxygen. If the bone
marrow cannot make enough platelets to make the blood clot normally, bleeding or bruising
may occur easily.
Leukemia can be acute (progressing quickly with many immature cells) or chronic
(progressing slowly with more mature, normal-looking cells). Chronic lymphocytic leukemia
progresses slowly and usually occurs in people 60 years of age or older. In the first
stages of the disease there are often no symptoms. As time goes on, more and more
lymphocytes are made and symptoms begin to appear. A doctor should be seen if the lymph
nodes swell, the spleen or liver becomes larger than normal, a feeling of fatigue
persists, or bleeding occurs easily.
If there are symptoms, a doctor will do a physical examination and may order blood
tests to count the number of each of the different kinds of blood cells. More blood tests
may be done if the results of the blood tests are not normal. The doctor also may do a
bone marrow biopsy. During this test, a needle is inserted into a bone and a small amount
of bone marrow is taken out and looked at under the microscope. The doctor can then tell
what kind of leukemia the patient has and plan the best treatment.
The chance of recovery (prognosis) depends on the stage of the disease, and the
patient's age and general health.
There are separate PDQ patient information summaries on acute lymphocytic leukemia
(adult and childhood), acute myeloid leukemia (adult and childhood), chronic myelogenous
leukemia, and hairy cell leukemia.
Stages of chronic lymphocytic leukemia
Once chronic lymphocytic leukemia has been found (diagnosed), more tests may be done to
find out if leukemia cells have spread to other parts of the body. This is called staging.
A doctor needs to know the stage of the disease to plan treatment. The following stages
are used for chronic lymphocytic leukemia:
Stage 0
There are too many lymphocytes in the blood, but there are usually no other symptoms of
leukemia. Lymph nodes and the spleen and liver are not swollen and the number of red blood
cells and platelets is normal.
Stage I
There are too many lymphocytes in the blood and lymph nodes are swollen. The spleen and
liver are not swollen and the number of blood cells and platelets is normal.
Stage II
There are too many lymphocytes in the blood and lymph nodes and the liver and spleen
are swollen.
Stage III
There are too many lymphocytes in the blood and there are too few red blood cells
(anemia). Lymph nodes and the liver or spleen may be swollen.
Stage IV
There are too many lymphocytes in the blood and too few platelets, which make it hard
for the blood to clot. The lymph nodes, liver, or spleen may be swollen and there may be
too few red blood cells (anemia).
Refractory
Refractory means that the leukemia does not respond to treatment.
How chronic lymphocytic leukemia is treated
There are treatments for all patients with chronic lymphocytic leukemia. Three kinds of
treatment are used:
- chemotherapy (using drugs to kill cancer cells)
radiation therapy (using high-dose x-rays or other high-energy rays to kill
- cancer cells)
treatment for complications of the leukemia, such as infection.
The use of biological therapy (using the body's immune system to fight cancer) is being
tested in clinical trials. Surgery may be used in certain cases.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it
may be put into the body by a needle in the vein or muscle. Chemotherapy is called a
systemic treatment because the drug enters the bloodstream, travels through the body, and
can kill cancer cells throughout the body.
Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink
tumors. Radiation for CLL usually comes from a machine outside the body (external
radiation therapy).
If the spleen is swollen, a doctor may take out the spleen in an operation called a
splenectomy. This is only done in rare cases.
Biological therapy tries to get the body to fight cancer. It uses materials made by the
body or made in a laboratory to boost, direct, or restore the body's natural defenses
against disease. Biological therapy is sometimes called biological response modifier (BRM)
therapy or immunotherapy.
Because infection often occurs in patients with CLL, a special substance called
immunoglobulin, which contains antibodies, may be given to prevent infections.
Sometimes a special machine is used to filter the blood to take out extra lymphocytes.
This is called leukapheresis.
Bone marrow transplantation is used to replace the bone marrow with healthy bone
marrow. First, all of the bone marrow in the body is destroyed with high doses of
chemotherapy with or without radiation therapy. Healthy marrow is then taken from another
person (a donor) whose tissue is the same as or almost the same as the patient's. The
donor may be a twin (the best match), a brother or sister, or another person not related.
The healthy marrow from the donor is given to the patient through a needle in the vein,
and the marrow replaces the marrow that was destroyed. A bone marrow transplant using
marrow from a relative or person not related to the patient is called an allogeneic bone
marrow transplant.
Another type of bone marrow transplant, called autologous bone marrow transplant, is
being studied in clinical trials. To do this type of transplant, bone marrow is taken from
the patient and treated with drugs to kill any cancer cells. The marrow is frozen to save
it. Next, the patient is given high-dose chemotherapy with or without radiation therapy to
destroy all of the remaining marrow. The frozen marrow that was saved is then thawed and
given back to the patient through a needle in a vein to replace the marrow that was
destroyed.
Treatment by stage
Treatment of chronic lymphocytic leukemia depends on the stage of the disease, and the
patient's age and overall health.
Standard treatment may be considered because of its effectiveness in patients in past
studies, or participation in a clinical trial may be considered. Most patients with
chronic lymphocytic leukemia are not cured with standard therapy and some standard
treatments may have more side effects than are desired. For these reasons, clinical trials
are designed to find better ways to treat cancer patients and are based on the most
up-to-date information. Clinical trials are on going in most parts of the country for most
stages of chronic lymphocytic leukemia. To know more about clinical trials, call the
Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
If the patient has stage 0 CLL, treatment may not be needed or chemotherapy may be
given. A doctor will follow the patient closely so treatment can be started if the
leukemia gets worse.
Treatment may be one of the following:
- 1. If there are no symptoms, no treatment may be needed. A doctor will follow the
patient closely so treatment can be started if the leukemia gets worse.
2. External radiation therapy to swollen lymph nodes.
3. Chemotherapy.
Treatment may be one of the following:
- 1. If there are few or no symptoms, no treatment may be needed. A doctor will follow the
patient closely so treatment can be started if the leukemia gets worse.
2. Chemotherapy.
3. Clinical trials of biological therapy.
4. External radiation therapy to the spleen.
Treatment may be one of the following:
- 1. Chemotherapy.
2. Clinical trials of bone marrow transplantation.
3. Surgery to remove the spleen (splenectomy).
4. External radiation therapy to the spleen.
5. External radiation therapy to the whole body (whole body radiation).
6. Clinical trials of biological therapy.
Treatment may be one of the following:
- 1. Chemotherapy.
2. Clinical trials of bone marrow transplantation.
3. Surgery to remove the spleen (splenectomy).
4. External radiation therapy to the spleen.
5. External radiation therapy to the whole body (whole body radiation).
6. Clinical trials of biological therapy.
Treatment depends on many factors; patients may wish to consider entering a clinical
trial of new chemotherapy drugs and bone marrow transplantation.
TO LEARN MORE..... CALL 1-800-4-CANCER
To learn more about chronic lymphocytic leukemia, call the National Cancer Institute's
Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By
dialing this toll-free number, trained information specialists can answer your questions.
The Cancer Information Service also has booklets that are available to the public and
can be sent on request. The following booklets about leukemia may be helpful:
- What You Need To Know About Leukemia
Research Report: Bone Marrow Transplantation
The following general booklets on questions related to cancer may also be helpful:
- What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
- Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again
There are many other places where people can get materials and information about cancer
treatment and services. The social service office at a hospital can be checked for local
and national agencies that help with getting information about finances, getting to and
from treatment, getting care at home, and dealing with problems.
For more information from the National Cancer Institute, please write to this address:
- National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
Date Last Modified: 11/97
If you want to know more about cancer and how it is treated, or if you wish to know
about clinical trials for your type of cancer, you can call the NCI's Cancer Information
Service at 1-800-422-6237, toll free. A trained information specialist can talk
with you and answer your questions.
Source: National Cancer Institute
National Institutes of Health
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