Treatment for chronic lymphocytic leukemia is in the midst of a revolutionary transformation. Clinicians and cancer researchers have embarked on a new era in the management of CLL with the development and approval of potent and effective targeted therapies. These therapies are tailored to individuals with leukemia based on the bio-markers or specific characteristics of their disease.
What is Chronic Lymphocytic Leukemia (CLL)?
Chronic lymphocytic leukemia (CLL) is a type of leukemia that begins in the bone marrow. Individuals with CLL produce too many lymphocytes (white blood cells) in their bone marrow.
In blood cancers like CLL, these blood cells can become abnormal, and as their numbers grow, there is less room for healthy white and red blood cells, and platelets, to develop. The abnormal white blood cells are not able to effectively defend the body from infections, and can cause the person to experience infections/illness, anemia and bleeding.
CLL is the most common type of leukemia in adults. There are almost 16,000 people diagnosed with CLL each year. The average age of a patient with newly diagnosed CLL is 72 years.
As its name suggests, CLL can be a chronic disease and progress very slowly, or it can progress quickly and require therapy. Your treatment will depend on how your disease progresses.
CLL Symptoms and Signs
When the lymph system produces antibodies or fights an infection, lymph nodes may become enlarged. This is normal. However, one of the most common symptoms of chronic lymphocytic leukemia (CLL) is swollen lymph nodes in the neck, chest or groin. If you have enlarged lymph nodes, it doesn't necessarily mean you have CLL. Other signs of CLL include:
- Fatigue
- Lethargy
- Night sweats
- Unexplained weight loss
- Unusual fullness after a meal
- Abdominal pain or swelling
- Fever and/or infection
- Bleeding
- Bruising
Types of Chronic Lymphocytic Leukemia
Chronic lymphocytic leukemia can be classified as either slow growing (indolent) or fast growing (aggressive).
Indolent CLL
Indolent CLL is slow growing and can remain stable without treatment for years.
If your CLL is indolent, it means that there are an increased number of lymphocytes in your blood, but your other blood cell counts are normal or only slightly below normal. Your physician may recommend "watchful waiting" in this situation.
Sometimes, patients with CLL in the early stages discover their illness when their primary care physician orders routine tests, or diagnostic tests for other symptoms. However, if you have slow growing CLL, you may not have symptoms of the disease.
Aggressive CLL
Aggressive CLL is fast growing and requires more immediate treatment. If your CLL is aggressive, it means that there are too many lymphocytes and abnormal cells leaving little to no room for other healthy blood cells. If you have aggressive CLL, you may have symptoms of the disease.
If left untreated, you can develop serious complications from the disease such as anemia and symptoms such as fatigue and shortness of breath, bleeding and difficulty fighting off infections or frequent infections. In extreme circumstances you may need transfusions of blood or platelets prior to the diagnosis of CLL.
How Is CLL Diagnosed?
Diagnosing chronic lymphocytic leukemia (CLL) requires a physical examination and examination of the blood. This includes review of a peripheral blood smear by the physician to identify CLL cells under the microscope. Then, a leukemia diagnostic test called "flow cytometry" is used to confirm the molecular markers on those cells are consistent with CLL cells.
Genetic testing, cytogenetics and other markers can help us define prognosis and select appropriate therapies. In general, most patients can have a diagnosis based on a physical examination and blood test. Sometimes, a bone marrow biopsy may be necessary.
Here are more tests for CLL and exams that may be used to diagnose and stage the disease:
- A physical exam and full medical history evaluation
- A complete blood count (CBC)
- A flow cytometry test to confirm the diagnosis of CLL
- Peripheral blood smear
- Bone marrow aspiration and biopsy
- Genetic testing, cytogenetics and other markers to help deliver a prognosis
Getting A Second Opinion from Penn
If you were diagnosed at another health care center, and are coming to Penn Medicine's Abramson Cancer Center for treatment, or for a second opinion, additional diagnostic tests may be necessary.
Penn utilizes specific diagnostic imaging tools, tests and procedures that are often more modern than what is available elsewhere. The results of these tools help us to develop your personalized treatment plan.
Staging CLL
Staging your chronic lymphocytic leukemia, along with knowing its clinical behavior, will help us create a treatment plan specific to you. CLL stages are determined using the Rai staging system:
- Stage 0: In this stage, there are circulating CLL cells without other abnormalities.
- Stage I: Your lymph nodes are involved.
- Stage II: Your spleen is involved.
- Stage III: You are anemic.
- Stage IV: You have low platelets.
It's important to know that the Rai staging system is different from other, traditional staging systems. More traditional, solid tumor staging systems may predict prognosis whereas Rai staging system doesn't necessarily mean you are at a poorer prognosis. Just because you are diagnosed at a higher stage doesn't mean your CLL cannot be managed. Our specialists will work with you to create a personalized treatment plan.
CLL Treatment Options
Your treatment for CLL greatly depends on the symptoms it is causing, your ongoing medical conditions and analysis of your specific prognostic factors.
Our CLL team including hematologists and medical oncologists, is a large multidisciplinary leukemia treatment team whose approach to cancer and blood disorders is to treat the entire individual — not just the disease.
Make an Appointment
Please call 800-789-7366 or request a callback.