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Chronic Lymphocytic Leukemia

The Wake Forest Baptist Approach Our Leukemia Program, which began in 1986, is widely recognized for excellence in patient care, teaching and clinical research. As one of the largest adult leukemia services in the Southeast, we are active in national research studies. Active collaboration between basic science laboratory research faculty and our own clinical researchers ensures that patients are offered cutting edge therapies. Among the research studies currently underway is a clinical trial evaluating the use of arsenic trioxide as part of a front line therapy for patients with acute promyelocytic leukemia (APL), a subtype that accounts for approximately 10 percent of all acute myeloid leukemia.  This research study is sponsored by Cancer and Leukemia Group B (CALGB), one of three major adult national cancer research groups. In addition to access to the latest treatments, some of the multidisciplinary services offered for our leukemia patients are nutritional consults, recreational therapy, pastoral care services and the Cancer Patient Support Program. Additionally, our oncology staff works with patients and families to identify support and resources in their home communities. Lymphomas, including Hodgkin’s Disease and the array of no n-Hodgkin’s lymphomas, represent a growing area of clinical interest at the Comprehensive Cancer Center. Treatment ranges from standard “treatment guideline” protocols to local and national research trials investigating cutting edge therapies. One particular area of emphasis is dose-intensive therapy followed by either bone marrow or peripheral stem cell transplantation.   Chronic lymphocytic leukemia (CLL) Bone marrow aspiration Auer rods Chronic lymphocytic leukemia - microscopic view Antibodies   Definition: Chronic lymphocytic leukemia is cancer of the white blood cells (lymphocytes). Alternative Names: CLL; Leukemia - chronic lymphocytic (CLL) Causes, incidence, and risk factors: Chronic lymphocytic leukemia (CLL) causes a slow increase in the number of B lymphocytes in the bone marrow. The cancerous cells spread from the blood marrow to the blood, and can also affect the lymph nodes and other organs. CLL causes the bone marrow to fail and weakens the immune system. The reason for this increase in B lymphocytes is unknown. There is no link to radiation, cancer-causing chemicals, or viruses. Usually, the symptoms develop gradually. Many cases are detected by routine blood tests in people with no symptoms. CLL primarily strikes adults. The average age of a patient with this type of leukemia is 70. It is rarely seen in people younger than 40. The disease is more common in Jewish people of Russian or East European descent, and is uncommon in Asia. Symptoms: Enlarged lymph nodes, liver, or spleen Fatigue Abnormal bruising (occurs late in the disease) Excessive sweating, night sweats Loss of appetite Unintentional weight loss Signs and tests: Patients with CLL have a higher-than-normal white blood cell count. Tests to diagnose CLL include: CBC Flow cytometry Bone marrow aspiration Serum protein electrophoresis If your doctor discovers you have CLL, tests will be done to see how much the cancer has spread. This is called staging. There are two methods to stage CLL. There are different ways to stage CLL. One system uses numbers to group CLL into low-, intermediate-, and high-risk categories. Generally, the higher the stage number, the more advanced the cancer. Another system uses letters to stage CLL according to how many lymph node groups are affected and whether or not you have a drop in red blood cells and platelets. Treatment: Early stage disease often requires no specific treatment, but it is important to be closely monitored by your doctor. Chemotherapy may be needed if fatigue, anemia, thrombocytopenia, or lymph node swelling occurs. Several chemotherapy drugs are commonly used to treat CLL. A common drug used is chlorambucil (Leukeran). Fludarabine and cyclophosphamide (Cytoxan) may also be used. Rituximab (Rituxan), may also be used alone or in combination with traditional chemotherapy. Alemtuzumab (Campath) is approved for treatment of patients with CLL that have not responded to fludarabine. Rarely, radiation may be used for enlarged lymph nodes. Blood transfusions or platelet transfusions may be required. Stem cell transplantation may be used in advances stages of CLL. Support Groups: The stress of illness may be eased by joining a support group whose members share common experiences and problems. Expectations (prognosis): The outlook depends on the stage of the disease. Half of patients diagnosed in the earliest stages of the disease live more than 12 years. Several new tests that look at cell and genetic changes can help predict life expectancy. Complications: Hypogammaglobulinemia (reduced levels of antibodies) -- increases the risk of infection Other cancer Side effects of chemotherapy Bleeding from low platelets Fatigue from anemia Autoimmune hemolytic anemia Idiopathic thrombocytopenic purpura (ITP) Calling your health care provider: Call health care provider if you develop enlarged lymph nodes or unexplained fatigue, bruising, excessive sweating, or weight loss. References: American Cancer Society. Cancer Facts and Figures 2006. Atlanta, Ga: American Cancer Society; 2006. Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG. Clinical Oncology. 3rd ed. Orlando, Fl: Churchill Livingstone; 2004:2921-2940.

Review Date:9/11/2006 Reviewed By:Corey Cutler, MD, MPH, FRCP(C), Assistant Professor of Medicine, Harvard Medical School; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA. Review provided by VeriMed Healthcare Network.