Hematology & Oncology
Chronic Lymphocytic Leukemia (CLL)
CLL is cancer of the white blood cells (lymphocytes), and is the most common type of leukemia. More than three fourths of the people who have chronic lymphocytic leukemia (CLL) are older than 60; the disease does not occur in children.
Symptoms of CLL
Chronic lymphocytic leukemia (CLL) symptoms usually develop over time. Early in the course of the disease, CLL often has little effect on a person's well-being. Some people with CLL do not have any symptoms. The disease may be suspected because of abnormal results from blood tests that were ordered either as part of an annual physical or a medical examination for an unrelated condition. An unexplained elevated white blood cell (lymphocyte) count is the most common finding that leads a physician to consider a CLL diagnosis.
People with CLL who do have symptoms may:
- Tire more easily, and/or feel short of breath during day-to-day physical activities—as a result of anemia (low red blood cell count).
- Lose weight because of decreased appetite and/or increased use of energy.
- Have lymph nodes and a spleen that may become enlarged as a result of an accumulation of CLL cells (leukemic lymphocytes).
- Have infections of the skin, lungs, kidneys or other sites that may occur as result of low immunoglobulin levels and decreased neutrophil counts.
Bone Marrow Tests
A bone marrow test is not typically needed for a CLL diagnosis to be confirmed. Instead, a physician or oncologist (cancer specialist) may want to examine bone marrow to establish a baseline. Bone marrow testing involves two steps usually done at the same time in a physician's office or a hospital:
- A bone marrow aspiration to remove a liquid marrow sample.
- A bone marrow biopsy to remove a small amount of bone filled with marrow.
Bone marrow will be examined to look at how cells are grouped and classify them into one of four kinds of CLL cell patterns:
Baseline test will establish:
- An increase in the number of lymphocytes in marrow.
- Often a decrease in the number of normal marrow cells.
Additional Lab Tests
After taking blood and bone marrow samples, a physician will work with a hematopathologist to confirm a diagnosis, identify the chronic lymphocytic leukemia (CLL) stage and look for certain changes in your chromosomes. A hematopathologist is a specialist who studies blood cell diseases by looking at samples of blood and marrow cells and other tissues.
The hematopathologist uses one or more lab tests such as those below to examine blood cells:
- An immunoglobulin test is used to check the immunoglobulin level in blood. Immunoglobulins, also called gamma globulins, are proteins called "antibodies" in the blood that fight infection. CLL cells do not make effective antibodies. CLL cells also interfere with the ability of the remaining normal lymphocytes to make antibodies. As a result, people with CLL often have low levels of immunoglobulins, which increase their risk of getting infections. If that's the case, immunoglobulin replacement may be used.
- Immunophenotyping looks for antigens on the surfaces of lymphocytes to determine whether they originated from a single cancer cell (monoclonal) and whether the CLL came from a B cell or a T cell. Flow cytometry is one type of test used for immunophenotyping.
- Fluorescence in situ hybridization (FISH) is a special test for studying chromosomes in tissue using DNA probes tagged with fluorescent molecules that emit light of different wavelengths (and different colors). FISH can be helpful in assessing risk and treatment needs, and for monitoring treatment effectiveness, by providing a sensitive test to see abnormal cells, such as cells with deletions of 17p.
- G-banding karyotyping examines your chromosomes' arrangement, size, shape and number using a special dye called Giemsa to get a better look at the banding patterns of chromosome pairs.
Current therapies do not offer patients a cure for CLL, but there are treatments that help manage the disease. Physicians use several types of approaches and treatment for adults with CLL, some at different stages:
- Watch and wait.
- Chemotherapy and drug therapy, including chemotherapy and monoclonal antibody therapy.
- Radiation therapy
- Supportive care
- Clinical trials can involve therapy with new drugs and new drug combinations or new approaches to stem cell transplantation.
The goals of CLL treatment are to:
- Slow the growth of CLL cells
- Provide long periods of remission (when there are no signs of CLL or patient feels well enough to carry on daily activities)
- Help patients feel better if you they are experiencing infections, fatigue or other symptoms
At NuFACTOR, we are committed to providing our patients all of the education, support and resources necessary to complete treatment successfully and with the desired outcomes. Please contact us with any further questions.
This content is not intended to substitute professional medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.