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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Chronic lymphocytic leukemia (CLL)

CLL; Leukemia - chronic lymphocytic (CLL)

Last reviewed: February 8, 2013.

Chronic lymphocytic leukemia (CLL) is cancer of a type of white blood cells called lymphocytes. These cells are found in the bone marrow and other parts of the body. Bone marrow is the soft tissue in the center of bones that helps form all blood cells.

CLL causes a slow increase in a certain type of white blood cells called B lymphocytes, or B cells. Cancer cells spread through the blood and bone marrow. CLL can also affect the lymph nodes or other organs such as the liver and spleen. CLL eventually can cause the bone marrow to lose its function.

Causes, incidence, and risk factors

The cause of CLL is unknown. There is no link to radiation. It is not clear whether certain chemicals cause CLL. But exposure to Agent Orange during the Vietnam War has been linked to an increased risk of getting CLL.

CLL usually affects older adults, especially those older than age 60. Persons under age 45 rarely get it. CLL is more common in whites than in other ethnic groups. It is more common in men than in women. Some persons with CLL have family members with the disease.

Symptoms

Symptoms usually develop slowly. CLL is often found by blood tests done in people for other reasons or who do not have any symptoms.

Symptoms of CLL include:

Signs and tests

Patients with CLL usually have a high white blood cell count.

Tests to diagnose CLL include:

  • Complete blood count (CBC) with white blood cell differential
  • Bone marrow biopsy
  • CT scan of the chest, abdomen, and pelvis
  • Immunoglobulin testing
  • Flow cytometry test of the white blood cells

If your doctor discovers you have CLL, tests will be done to see how much the cancer has spread. This is called staging.

Tests that look at changes in DNA inside the cancer cells may also be done. Results from these tests can from staging tests help your doctor determine your treatment.

Treatment

If you have early stage CLL, your doctor will monitor you closely. Usually, no medicines or other treatment is given for early-stage CLL, unless you have:

  • A high-risk type of CLL
  • Infections that keep coming back
  • Leukemia that is rapidly getting worse
  • Low red blood cells or platelet counts
  • Fatigue, loss of appetite, weight loss, or night sweats
  • Painful swollen lymph nodes

Chemotherapy medicines are used to treat CLL. Your doctor will determine which ones are right for you.

In rare cases, radiation is used for painful and enlarged lymph nodes.

Blood transfusions or platelet transfusions may be required if blood counts are low.

Bone marrow or stem cell transplantation may be used in younger patients with advanced or high-risk CLL. A transplant is the only therapy that offers a potential cure for CLL.

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Expectations (prognosis)

How well a patient does depends on the stage of the cancer. About half of patients diagnosed in the early stages of CLL live more than 12 years.

Complications

  • Autoimmune hemolytic anemia
  • Bleeding from low platelet count
  • Hypogammaglobulinemia, a condition in which you have lower levels of antibodies, which increases your risk of infection
  • Infections that keep coming back (recur)
  • Overwhelming fatigue
  • Other cancers, including a much more aggressive lymphoma (Richter’s transformation)
  • Side effects of chemotherapy

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

  1. Kantarjian H, O'Brien S. The chronic leukemias. In: Goldman L, SchaferAI, eds. Goldman’s Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 190.
  2. Lin TS, Awan FT, Byrd JC. Chronic lymphocytic leukemia. In: Hoffman R, Benz EJ Jr, Silberstein LE, et al., eds. Hematology: Basic Principles and Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 76.
  3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Non-Hodgkin’s Lymphomas. Version 1.2013. Available at http://www.nccn.org/professionals/physician_gls/pdf/nhl.pdf. Accessed January 2, 2013.

Review Date: 2/8/2013.

Reviewed by: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Blackman, Stephanie Slon, and Nissi Wang.

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

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  • The role of the monoclonal anti‐CD20 antibodies for treatment of patients with chronic lymphocytic leukaemia
    Chronic lymphocytic leukaemia (CLL) is a malignant disease and accounts for 25% of all leukaemias. The disease is the most common lymphoid malignancy in western countries, and is characterised by a highly variable clinical course and prognosis. Some patients may have minimal or no symptoms for many years with a normal life expectancy, without requiring treatment. Other people are symptomatic at diagnosis or soon thereafter and can experience infectious and autoimmune complications, leading to a reduced lifespan. Standard treatment includes chemotherapy with one or more agents. Presently monoclonal antibodies are added, especially alemtuzumab and rituximab. However, the impact of these agents remains unclear, as there have been hints for increased overall survival, but also for an increased risk of severe infections in non‐randomised trials. In this systematic review we summarised and analysed the evidence from randomised controlled trials on efficacy and safety of monoclonal anti‐CD20 antibodies (such as rituximab and ofatumumab) in the treatment of CLL. We searched medical databases, such as EMBASE, MEDLINE and CENTRAL, and found seven randomised controlled trials fulfilling our inclusion criteria. Included trials compared anti‐CD20 antibodies, particularly rituximab, to no further therapy or compared to anti‐cancer therapy in CLL, irrespective of whether the patients were newly diagnosed or relapsed patients. Only five of the seven identified trials could be included in one of the two performed meta‐analyses.
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Figures

  • Bone marrow aspiration.
    Auer rods.
    Chronic lymphocytic leukemia - microscopic view.
    Antibodies.

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