Chronic lymphocytic leukemia (CLL) is a type of cancer in which a person’s bone marrow produces too many lymphocytes, which are small white blood cells that facilitate the body’s immune response. This type of leukemia is very similar to acute lymphocytic leukemia, although the term “chronic” indicates that it develops slowly over time (in contrast to acute leukemia, which progresses much more rapidly).
Unlike acute lymphocytic leukemia, which is the most commonly diagnosed cancer in children, chronic lymphocytic leukemia primarily affects adults. Because abnormal blood cells accumulate slowly with chronic leukemias, an individual may have cancer for several years before experiencing any symptoms, and the cancer may spread to the lymph nodes, liver and/or spleen before it is diagnosed. Therefore, CLL requires carefully planned – and even more carefully delivered – treatment.
What causes chronic lymphocytic leukemia?
Exactly what causes CLL, or any cancer for that matter, can’t be pinpointed, but it is known that changes occur at the cellular level – in the instance of CLL, these mutations occur in cells within the bone marrow that otherwise develop into a type of white blood cell called “lymphocytes.” The mutation causes these cells to survive longer than normal cells and build up in the bone marrow, instead of dying off. The leukemia cells can then spill over into the bloodstream and spread to other organs.
Symptoms of chronic lymphocytic leukemia
Most people with chronic lymphocytic leukemia do not experience any symptoms prior to being diagnosed. More often than not, CLL is diagnosed after blood work is run for another purpose, be it an unrelated health issue or just a routine check-up, and reveals a high lymphocyte count.
When CLL does produce symptoms, they are usually vague symptoms that could be attributed to other health issues. These include symptoms such as:
- Unexplained weight loss
- Chills or fever
- Night sweats
- Swollen lymph nodes
- Pain or a feeling of “fullness” in the stomach (actually caused by an enlarged spleen and/or liver)
Symptoms of advanced CLL
As chronic lymphocytic leukemia progresses and the leukemia cells crowd out normal bone marrow cells, other signs and symptoms can occur. Healthy bone marrow cells include red blood cells, white blood cells and blood platelets, and as these healthy cells are depleted, patients may experience:
- Anemia, caused by a reduction in red blood cells – Anemia can lead to tiredness, muscle weakness and shortness of breath.
- An increased risk of infection, caused by leukopenia, a shortage of healthy white blood cells – CLL prevents the B lymphocytes (cells that make antibodies to fight infection) from working properly. Infections can range from the common cold to more serious conditions like pneumonia.
- Excess bruising or bleeding, caused by a low blood platelet count – This could include frequent nosebleeds and bleeding gums.
Chronic lymphocytic leukemia risk factors
Unlike some forms of cancer, CLL does not seem to be linked with diet, smoking or any particular infections. There are just a few known risk factors for chronic lymphocytic leukemia, which include the following:
- Age – As with many other forms of cancer, risk for developing CLL increases with age. About 90% of people diagnosed with CLL are over the age of 50.
- Family history – People with parents, siblings or children with CLL have more than twice the risk of developing CLL themselves.
- Gender – CLL is slightly more prevalent in males.
- Exposure to certain chemicals – CLL risk has been linked with exposure to radon in the home, as well as Agent Orange, an herbicide used during the Vietnam War. Some studies have also linked farming and long-term exposure to pesticides to an increased risk for CLL, but more research is needed.
- Race/ethnicity – CLL has shown more prevalence in North America and Europe than in Asia. Researchers believe this risk is genetic rather than environmental, as Asian Americans have not been shown to have an increased risk.
Treatment options for chronic lymphocytic leukemia
Because CLL is a slow-growing cancer and its treatment can cause side effects, oncologists may suggest waiting before beginning therapy. When treatment becomes necessary, plans vary from patient to patient, as many individual factors need to be taken into consideration. Generally speaking, the main treatments for CLL typically include chemotherapy, monoclonal antibodies, targeted therapy and/or stem cell transplantation, along with supportive care. Other first-line therapies used for CLL treatment may include radiation therapy, surgery or leukapheresis.
Moffitt’s approach to treating chronic lymphocytic leukemia
At Moffitt Cancer Center, we have the necessary experience to treat chronic lymphocytic leukemia as well as other types of leukemia and cancers that develop in the blood and bone marrow. Our Malignant Hematology Program is specifically dedicated to researching, diagnosing and treating these unique conditions; as a result, our patients have opportunities to work with medical professionals who are among the most highly specialized in their respective fields.
Several forms of treatment are often required for a patient to achieve long-term remission, and Moffitt makes it possible for patients to access many different services in a single, convenient location. Here, even without an outside physician’s referral, patients with chronic lymphocytic leukemia can consult with:
- Medical oncologists
- Radiation oncologists
- Clinical trial organizers and research professionals
- Emotional and spiritual care providers
- Advanced practice nurses
Our multispecialty team will regularly assess a patient’s progress, making any necessary adjustments to his or her chronic lymphocytic leukemia treatment plan. We may recommend a combination of chemotherapy, targeted therapies, radiation therapy and supportive treatments, with the specific details tailored to a patient’s unique diagnosis. And, to give our patients the best possible chances of maintaining high-quality lives and long-term remission, we can coordinate the various aspects of follow-up treatment and bloodwork. Consolidation therapies for CLL, such as bone marrow transplantation, can also be arranged at Moffitt.
"Moffitt Cancer is the only institution in the Southeast of US who has specialized Hematologist that treat CML/CLL."- Javier Pinilla, MD, Malignant Hematology