Chronic Lymphocytic Leukemia (CLL)
Understanding CLL
Chronic Lymphocytic Leukemia (CLL) is a disease of the white blood cells that affects B-cells. B-cells originate in the bone marrow, develop in the lymph nodes, and normally fight infection by producing antibodies. In CLL, the B-cells do not work effectively and adversely affect the immune system. The disease causes an increase in B-cells in the bone marrow, which crowds out healthy cells. This disease primarily affects adults over the age of 50 and is rarely seen in children.
Symptoms of CLL
Most people do not have symptoms when diagnosed with Chronic Lymphocytic Leukemia (CLL). Some patients may present with enlarged lymph nodes. If the disease is diagnosed at a later stage, patients may report fatigue, fever, night sweats, weight loss, pain in the upper left portion of the abdomen (due to an enlarged spleen) and frequent infections.
Diagnosing CLL
Diagnosing Chronic Lymphocytic Leukemia (CLL) is easily done with blood tests. Usually, a patient presents with an increased lymphocyte count greater than 5,000 cells per microliter of blood on a routine complete blood count (CBC) test. The diagnosis is based on the finding of abnormal B-cells in the blood, bone marrow, or lymphatic tissue effected. The presence of lymphocytosis (high lymphocyte count) in an adult may raise strong suspicion for CLL, and a confirmatory diagnostic test (in particular flow cytometry) should be performed.
Flow cytometry and microscopic exam of blood are the tools for proper diagnosis. Flow cytometry measures specific markers on cells. CD molecules are surface molecules expressed on cells of the immune system that play key roles in immunity. Normal B-cells express CD 19 and CD 20. In CLL, the B-cells also express CD 5 and CD23. When looking at them under the microscope, the CLL cells are smaller and more fragile than normal B-cells.
Treatment of CLL
Treatment of Chronic Lymphocytic Leukemia (CLL) may vary depending on the stage in which a person is diagnosed. Early stage CLL does not need to be treated and is termed a “watch and wait” period. CLL is a slow-growing disease, so patients can live normal lives without treatment for as long as a decade. Treatment is usually initiated when the patient’s clinical symptoms (which can include severe fatigue, fever, night sweats, weight loss, enlarged lymph nodes,) or blood counts indicate the disease has progressed to a point where it may affect the patient’s quality of life. Chemotherapy is used as treatment for CLL. There are several different regimens used to treat CLL. These agents generally allow patients to go into remission. If a patient has refractory or recurrent disease, a bone marrow transplant may be indicated. At this time, bone marrow transplant may be the only therapy considered curative for CLL.
Role of Immune Globulin Therapy
Immune globulins are found naturally in the body and help fight infection. Some patients with CLL may have low levels of antibodies, which may cause recurrent infections, and may benefit from immune globulin replacement therapy. Immune globulin is extracted from a large pool of human plasma and contains all the important antibodies present in the normal population. Immune globulin therapy can be administered into the blood stream intravenously (IVIG) or under the skin subcutaneously (SCIG).
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