Chronic Lymphocytic Leukemia (CLL) is slow-progressing or “chronic”, cancer of the blood and bone marrow. CLL is the second most common leukemia in adults and one of the four primary types of leukemia. Certain risk factors have been identified including age, race, sex, family history of blood and bone marrow cancers and chemical exposure. Most people diagnosed with CLL are white males over the age of 60. Occurrence increases with age and a marked increase after 60. Herbicides, insecticides and Agent Orange used in the Vietnam War have shown to increase the risk of developing CLL. There are approximately 15,000 new cases diagnosed each year.
The cause of CLL is unknown at this time but much research is being put into finding the cause. Since the cause is unknown, there is no way to prevent CLL. One recent study has identified skewed kappa-lambda free light chain ratio up to nine years prior to the onset of CLL. The National Institutes of Health has established that monoclonal B-cell lymphocytosis results in higher risk of developing CLL.
95% of the genetic mutations resulting in CLL are in B-cells. The other 5% are in T- or NK-cells. These mutations result in abnormal lymphocytes (leukemic cells). As the cancer progresses from the blood to the marrow, the increased number of cancerous cells push healthy white blood cells, red blood cells and platelets out of the bone marrow. This “takeover” of the marrow can result in anemia, reduced ability to fight infection and easy bleeding. The increased rates of secondary infections are the result of decreased infection-fighting capacity of white blood cells.
A patient with CLL can go undiagnosed for years as it is usually asymptomatic and has little effect on a patient’s health in the early stages. CLL is usually found during a regular checkup. The signs and symptoms are most likely caused by opportunistic infections due to the decreased white blood cell count. Symptoms can include:
• Painless swelling of the spleen or lymph nodes in neck, underarm, stomach or groin
• Tiring easily
• Shortness of breath
• Pain/fullness between the ribs
• Fever and infection
• Unexplained weight loss
CLL is diagnosed with a physical exam, including a complete history, and blood & bone marrow tests. Many types of blood and bone marrow tests can be performed including:
• Complete blood count – Hematocrit, white blood cell count, platelet count and hemoglobin concentration.
• Cytogenic analysis – Microscopic examination of lymphocytes to look for structural changes or changes in number of chromosomes.
• Immunophenotyping – Microscopic examination to determine if CLL is from B or T cells.
• Bone marrow aspiration & biopsy – Removal of bone marrow, blood and small piece of bone from the hip or breastbone. A pathologist will then review for abnormal cells.
It is extremely important to be treated by a...