Chronic Lymphocytic Leukemia

• Chronic lymphocytic leukemia (also called CLL) is a cancer of the blood and bone marrow that usually gets worse slowly. CLL is one of the most common types of leukemia in adults.
• It often occurs during or after middle age; it rarely occurs in children.
• CLL may affect red blood cells, white blood cells, and platelets.
• Signs and symptoms of chronic lymphocytic leukemia include swollen lymph nodes and feeling tired.
• Tests that examine the blood are used to diagnose chronic lymphocytic leukemia.

Leukemia may affect red blood cells, white blood cells, and platelets

Normally, the bone marrow makes blood stem cells (immature cells) that become mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell.

A myeloid stem cell becomes one of three types of mature blood cells:

• Red blood cells that carry oxygen and other substances to all tissues of the body.
• White blood cells that fight infection and disease.
• Platelets that form blood clots to stop bleeding.

A lymphoid stem cell becomes a lymphoblast cell and then one of three types of lymphocytes (white blood cells):

• B lymphocytes that make antibodies to help fight infection.
• T lymphocytes that help B lymphocytes make the antibodies that help fight infection.
• Natural killer cells that attack cancer cells and viruses.

CLL

• In CLL, too many blood stem cells become abnormal lymphocytes.
• The abnormal lymphocytes may also be called leukemia cells.
• These leukemia cells are not able to fight infection very well.
• Also, as the number of leukemia cells increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets.
• This may lead to infection, anemia, and easy bleeding.

Signs and symptoms of chronic lymphocytic leukemia:

• In the beginning, CLL does not cause any signs or symptoms and may be found during a routine blood test.
• Painless swelling of the lymph nodes in the neck, underarm, stomach, or groin.
• Weakness or feeling tired.
• Pain or a feeling of fullness below the ribs.
• Fever and infection.
• Easy bruising or bleeding.
• Petechiae (flat, pinpoint, dark-red spots under the skin caused by bleeding).
• Weight loss for no known reason.
• Drenching night sweats.

Tests used to diagnose chronic lymphocytic leukemia

• Physical exam and health history: An exam of the body to check general signs of health, including checking for enlarged lymph nodes or liver or spleen.
• Complete blood count (CBC) with differential: A sample of blood is drawn and checked for the following:
  • The number of red blood cells and platelets.
  • The number and type of white blood cells.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
• Blood chemistry studies
• Lactate dehydrogenase testing: An increased amount of lactate dehydrogenase in the blood may be a sign of tissue damage and some types of cancer or other diseases.
• Beta-2-microglobulin testing: A laboratory test for beta-2-microglobulin
• Flow cytometry: The cells from a sample of a patient’s blood, bone marrow, or other tissue are stained with a fluorescent dye, and then passed one at a time through a beam of light. The test results are based on how the cells that were stained with the fluorescent dye react to the beam of light. This test is used to help diagnose and manage certain types of cancers, such as leukemia and lymphoma.
• FISH (fluorescence in situ hybridization): A laboratory test used to look at and count genes or chromosomes in cells and tissues. The FISH test is used to help diagnose cancer and help plan treatment.
• Gene mutation testing: A laboratory test in which cells or tissue are analyzed to look for changes in the TP53 or IgVH gene. These changes may be helpful to determine the patient's prognosis.
• Serum immunoglobulin testing: A laboratory test that measures specific types of immunoglobulins (antibodies) in the blood.

CLL prognosis depends on the following:

• Whether there are certain gene changes, such as TP53 or IgVH mutations.
• Whether lymphocytes have spread throughout the bone marrow.
• Whether the red blood cell and platelet counts are low.
• Whether the white blood cell count is increasing quickly.
• The stage of the cancer.
• The results of certain blood tests, such as the beta-2 microglobulin test.
• The patient's age and general health.
• How quickly and how low the leukemia cell count drops during treatment.
• Whether the CLL gets better with treatment or has recurred (come back).
• Whether the CLL progresses to lymphoma or becomes prolymphocytic leukemia.
• Whether the patient gets another type of cancer after being diagnosed with CLL.

CLL Stages:

Stage 0: In stage 0 chronic lymphocytic leukemia, there are too many lymphocytes in the blood, but there are no other signs or symptoms of leukemia.

Stage I: In stage I chronic lymphocytic leukemia, there are too many lymphocytes in the blood and the lymph nodes are larger than normal.

Stage II: In stage II chronic lymphocytic leukemia, there are too many lymphocytes in the blood, the liver or spleen is larger than normal, and the lymph nodes may be larger than normal.

Stage III: In stage III chronic lymphocytic leukemia, there are too many lymphocytes in the blood and there are too few red blood cells.

Stage IV: In stage IV chronic lymphocytic leukemia, there are too many lymphocytes in the blood and too few platelets.