Chronic Lymphocytic Leukemia

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KEY POINTS

• Chronic lymphocytic leukemia (CLL) is a cancer of the blood and bone marrow. It affects a type of white blood cells called lymphocytes.
• Treatment may include radiation therapy, chemotherapy, stem cell transplant, or a combination of these and other therapies.
• Follow the full course of treatment prescribed by your healthcare provider. Ask your provider how to take care of yourself at home.

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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. These abnormal cells crowd out normal blood cells in the bone marrow. The abnormal cells may also group together in the lymph nodes and spleen and travel through the blood stream.

The sooner cancer is found and treated, the better your chances for recovery. However, even advanced cancer can usually be treated. Treatment may slow or stop the growth of the cancer and ease symptoms for a time. Ask your healthcare provider what you can expect with the type of cancer that you have.

What is the cause?

The cancer starts in the bone marrow. Marrow is the soft, fatty tissue inside hard bone. The marrow is where blood cells are formed.

• White blood cells help fight off infection.
• Red blood cells carry oxygen and nutrients to your body.
• Platelets help your blood clot.

Normally, lymphocytes help your body fight infection and other diseases. Chronic lymphocytic leukemia happens when your body makes too many abnormal lymphocytes. The abnormal cells crowd out other, normal blood cells needed by your body.

• The abnormal white cells cannot fight infections.
• Fewer red blood cells make you tired and weak.
• Fewer platelets cause you to bleed easily.

The cancer can also spread to other parts of your body.

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?

Often the first symptoms are the same as other diseases. Symptoms may include:

• Swollen 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?

Your healthcare provider usually discovers the disease during a routine blood test. The blood test will show an abnormally high white blood cell count. You may have a bone marrow biopsy, which uses a needle passed through the skin to take a small sample of tissue for testing, usually from the back pelvic bone.

How is it treated?

You and your healthcare provider will discuss possible treatments. You may also talk with a cancer specialist. Some things to think about when making treatment decisions are:

• Your age
• Your overall health
• The stage of the cancer (how advanced the cancer is)
• Whether the cancer has spread to other parts of your body such as the lymph nodes and spleen
• The genetic makeup of your cancer cells

There is no cure for the disease, so treatment focuses on controlling the symptoms.

In the early stage of CLL, when you have no signs or symptoms, you may not need treatment. You may need to see your healthcare provider every few months. Delaying treatment means that you avoid the side effects that go along with chemotherapy, but it also means that you may miss a chance to treat your condition before it gets worse.

When your disease requires treatment, possible treatments are:

• Chemotherapy (anticancer drugs), which uses medicine to kill cancer cells
• Steroid medicine to help control the growth of CLL cells
• Stem cell or bone marrow transplant, which uses your own cells or cells from a donor
• Radiation therapy, which uses high-energy X-rays to kill cancer cells in the lymph nodes
• Artificial targeted antibodies that help your body's immune system destroy leukemia cells

Your treatment will also include:

• Preventing infections
• Controlling pain or other symptoms you may have
• Controlling the side effects from treatments
• Helping you manage your life with cancer

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 cancer cells are growing. You will need to have regular follow-up visits with your healthcare provider.

Ask your healthcare provider about clinical trials that might be available to you. Clinical trials are research studies to find effective cancer treatments. It’s always your choice whether you take part in one or not.

How can I take care of myself?

If you have been diagnosed with CLL:

• Talk about your cancer and treatment options with your healthcare provider. Make sure you understand your choices.
• Follow the full course of treatment prescribed by your healthcare provider.
• Ask your healthcare provider:
  • How and when you will get your test results
  • How long it will take to recover
  • If there are activities you should avoid and when you can return to your normal activities
  • How to take care of yourself at home
  • What symptoms or problems you should watch for and what to do if you have them
• Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

Other things that may help include:

• Eat a healthy diet and get regular exercise as recommended by your healthcare provider.
• Get plenty of rest.
• Try to reduce stress and take time for activities that you enjoy. It may help to talk with a counselor about your illness.
• Talk with your family and your healthcare providers about your concerns. Ask your healthcare provider any questions you have about the disease, treatments, side effects of the treatments, sexual activity, support groups, and anything else that concerns you.
• If you smoke, try to quit.
• 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.
• Tell your provider if your treatment causes discomfort. Usually there are ways to help you be more comfortable.

For more information, contact:

• Leukemia and Lymphoma Society
  800-955-4572
  http://www.lls.org/