Chronic lymphocytic leukemia (patient information)

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Editor-in-Chief: C. Michael Gibson, M.S.,M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Associate Editor-In-Chief: Jinhui Wu, M.D.

Overview
Chronic lymphocytic leukemia (CLL) is the second most common type of leukemia in adults. It often occurs during or after middle age and rarely occurs in children. This type of cancer starts from lymphocytes in the bone marrow and then invades the blood. Usually CLL does not cause any symptoms and is found during a routine blood test. Possible signs include swollen lymph nodes and tiredness. Treatments include bone marrow or peripheral blood stem cell transplantation, monoclonal antibodies, surgery, radiation and chemotherapy.

What are the symptoms of Chronic lymphocytic leukemia?
Early chronic lymphocytic leukemia does not have any symptoms. As the tumor grows larger, people may notice one or more of the following symptoms:


 * Weakness and fatigue
 * Weight loss
 * Fever and infection
 * Night sweats
 * Painless swelling of the lymph nodes in the neck, underarm, or groin
 * Pain or fullness below the ribs

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell the doctor so that the problems can be diagnosed and treated as early as possible.

Who is at highest risk?
Clinical data has suggested that the development of chronic lymphocytic leukemia is related to several factors.


 * Certain chemical exposures: Studies suggest that some herbicides and insecticides used in farming may increase the risk of chronic lymphocytic leukemia.


 * Family history: Epidemic survey show that first-degree relatives of chronic lymphocytic leukemia patients have an increased risk for this cancer.


 * Gender: Clinical data show chronic lymphocytic leukemia is more common in men than women.


 * Race: Chronic lymphocytic leukemia is more common in North America and Europe than in Asia.

When to seek urgent medical care?
Call your health care provider if symptoms of chronic lymphocytic leukemia develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:


 * Hyperpyrexia
 * Severe infection
 * Severe abdominal pain

Diagnosis

 * Blood cell tests: Most chronic lymphocytic leukemia patients have too many of lymphocytes and too few red blood cells and platelets. Besides counting the blood cells, doctors use a number of very precise lab tests, such as cytochemistry, flow cytometry, FISH, immunocytochemistry, cytogenetics, and molecular genetic studies, to diagnose and classify leukemia.


 * Bone marrow aspiration and biopsy: The doctor uses a thin needle to draw up a small amount of liquid bone marrow, then a biopsy sample is usually removed and looked at under a microscope.


 * Excisional lymph node biopsy: The surgeon cut your lymph node on tne surface of your skin. And, the biopsy sample is usually removed and looked at under a microscope.


 * Images tests such as computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, ultrasound and chest-x-ray: The goal of these image tests are to help find out the extent of the chronic lymphocytic leukemia and determine the stage of the disease.

Treatment options
Chronic lymphocytic leukemia progresses slowly in most cases. Patients have many treatment options. The selection depends on the stage of the disease. The options are bone marrow or peripheral blood stem cell transplant (SCT), monoclonal antibodies, radiation therapy, chemotherapy and surgery. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may change from one treatment session to the next.


 * Bone marrow or peripheral blood stem cell transplant (SCT): This is a very complex and expensive treatment. Go to ask your doctor for more details. The blood-forming stem cells can come from either the patient or from a donor whose tissue type closely matches that of the patient.


 * Monoclonal antibodies: This kind of treatment can help the patient immune system to react to cancer cells and destroy them by injection either under the skin or into a vein.


 * Chemotherapy: The treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing.


 * Radiation therapy: This is a cancer treatment to kill cancer cells or keep them from growing by using high-energy x-rays or other types of radiation.


 * Surgery: Surgery is rarely used in the treatment of leukemia. An operation may be done to remove the spleen to releasing the press on other organs.

Diseases with similar symptoms
Other health problems may also cause similar symptoms. Go to see your doctor to verify your diseases as early as possible. Diseases with similar symptoms are listed in the following:


 * Any infections which ncan make lymph nodes enlarge


 * Lymph nodes tuberculosis


 * Hodgkin's lymphoma


 * Non-Hodgkin's lymphoma


 * B cell prolymphocytic leukemia


 * Hairy cell leukemia

Where to find medical care for Chronic lymphocytic leukemia?
Directions to Hospitals Treating Chronic lymphocytic leukemia

Prevention of Chronic lymphocytic leukemia
Chronic lymphocytic leukemia is not related with life style, so there is no known risk factors for people to change. Current data show that avoidance of certain chemical exposures such as herbicides and insecticides may be helpful. But more researches are needed to verify.

What to expect (Outlook/Prognosis)?
The prognosis of chronic lymphocytic leukemia depends on:


 * The stage of chronic lymphocytic leukemia, whether lymphocytes are spread throughout the bone marrow, whether the chronic lymphocytic leukemia progresses to lymphoma or prolymphocytic leukemia.


 * Treatment response: Whether the chronic lymphocytic leukemia patient gets better with treatment or has come back.


 * The patient's general health.