Lymphocytic Leukemia

Chronic Lymphocytic Leukemia (CLL) refers to the cancer of blood and bone marrow. Bone marrow is soft, spongy tissues present in the interior of your bones which produce blood cells.

The name “chronic lymphocytic leukemia” refers to slow progressive development of the disease (chronic) that occurs in a group of white blood cells called lymphocytes.

Early detection and treatment can keep disease advancement in check while ensuring better outcomes.

Cancer is a serious health condition that requires immediate medical attention. Talk to your doctor if you observe any of the above signs and symptoms.

The symptoms do not manifest early in people with chronic lymphocytic leukemia.

You may experience signs and symptoms like:

• Enlarged, but painless, lymph nodes
• Fatigue
• Fever
• Pain in the upper left portion of the abdomen, which may be due to an enlarged spleen
• Night sweats
• Weight loss
• Frequent infections

The exact cause behind chronic lymphocytic leukemia is still a mystery. However, various inherited and acquired factors have been known to cause genetic mutations in the DNA of blood-producing cells. Mutated genes result in the production of abnormal lymphocytes that multiply and grow at an uncontrolled rate. The accumulation of abnormal lymphocytes in the blood and certain organs are associated with various complications and may interfere with normal blood cell production.

Scientific researches are being carried out to identify the exact cause behind chronic lymphocytic leukemia.

Seek immediate help if you suspect any associated signs and symptoms. You may have to see with Hematologist after consultation with your doctor. Be prepared for any pre-appointment requirements.

These tips might help you make the appointment more productive:

• Make a list of all medications, vitamins or supplements that you're taking. Take a family member or friend to accompany you.
• List out the questions that you wish to ask your doctor (starting from most important to the least ones).

Include the following questions:

• What does my test result mean?
• What are my treatment options?
• What are the side effects associated with my treatment?
• Does the treatment interfere with my daily life?
• Are there any brochures or other printed material that I can take with me?
• What websites do you recommend?

Ask any other question that might strike your head during the conversation.

What to expect from your doctor

Your doctor may ask:

• When did symptoms start appearing?
• What are the common symptoms? How severe are they?
• Are the symptoms continuous or episodic?

Tests and procedures used to diagnose chronic lymphocytic leukemia include:

• Blood tests: A complete blood count is taken to determine the number of lymphocytes in a blood sample. A high number of B cells indicates chronic lymphocytic leukemia.

Determine the type of lymphocytes involved

Flow cytometry or immune-phenotyping: This procedure helps to determine whether an increased number of lymphocytes is due to chronic lymphocytic leukemia, a different blood disorder or your body's reaction to infection. Flow cytometry helps to predict aggressiveness of the leukemic cells.

Analyze lymphocytes for genetic abnormalities

Fluorescence in situ hybridization (FISH) is a procedure that involves examination of the chromosomes from the abnormal lymphocytes for abnormalities. This information can also be used to determine your prognosis and choose a treatment.
Other tests include: Bone marrow biopsy and aspiration and imaging tests, such as computerized tomography (CT).

Staging

The stages of chronic lymphocytic leukemia are indicative of disease progression and its aggression. Staging is important to determine treatment options and therapeutic outcomes of a treatment. The stages are: early, intermediate or advanced. Early-stage patients may not require immediate treatment whereas those with intermediate-stage disease and advanced-stage disease need immediate medical treatment.

Treatment for chronic lymphocytic leukemia depends on several factors, such as the stage of cancer, severity of signs and symptoms, general health, and personal preferences.

• People in the early-stage of chronic lymphocytic leukemia typically don't receive treatment. Studies have shown that early treatment doesn't extend lives for people with early-stage chronic lymphocytic leukemia rather put you through the potential side effects and complications of treatment.
• Treatments for intermediate and advanced stages.

Chemotherapy

Chemotherapy employs chemical drugs to destroy cancer cells. Single or multiple drugs may be administered via oral or intravenous routes.

Targeted drug therapy

It involves targeting specific molecules present in the cancer cells that cause abnormal cell growth.

Targeted therapy drugs used in treating chronic lymphocytic leukemia include:

• rituximab (Rituxan),
• alemtuzumab (Campath)
• ofatumumab (Arzerra)

Bone marrow stem cell transplant

First the stem cells in bone marrow that produce abnormal lymphocytes are destroyed by using strong chemotherapeutic agents. Then after, Healthy stem cells from a donor are infused into blood of the patient to replace the unhealthy cells.

A reduced intensity, or "mini," bone marrow stem cell transplant uses lower doses of chemotherapy drugs and is similar to a standard stem cell transplant. Bone marrow stem cells may be an alternative treatment when other treatments haven't worked or for certain cases of very aggressive forms of chronic lymphocytic leukemia.

Supportive care may include:

• Screening to evaluate the risk of other types of cancer. For instance, annual skin examination may be recommended to look for signs of skin cancer.
• Vaccinations to prevent infections such as pneumonia and influenza.
• Monitoring for other health problems during and after treatment for chronic lymphocytic leukemia.

Currently, there are no alternative remedies that can cure chronic lymphocytic leukemia. However alternative treatments can be helpful to manage stress and other symptoms associated with the disease and its treatment.

• Alternative treatments for coping with fatigue include Exercise, Massage, Meditation, Relaxation techniques, Yoga etc.
• Green tea extracts has a compound called EGCG, taken in the pill form that can kill chronic lymphocytic leukemia cells and reduce some signs of the disease. Research on EGCG and green tea is ongoing. Though considered safe, EGCG, at high doses, can cause complications, such as liver problems, and it may interfere with some medications. Side effects include nausea, abdominal pain and indigestion.

Lifestyle modifications are necessary in order to cope with chronic lymphocytic leukemia.

• Avoid conditions that expose you to infectious agents as people with chronic lymphocytic leukemia are prone to frequent infection.
• Eat a healthy diet. Feast on fruits and vegetables.
• Get enough sleep.
• Get active, indulge in some exercise program and follow with discipline.
• Wash your hands frequently to avoid catching germs.
• Get immunized, annual flu shot is recommended.
• People with chronic lymphocytic leukemia are at a risk of second cancers. Lifestyle changes may help reduce the risk, such as not smoking, and drinking alcohol in moderation, eating a healthy plant-based diet and using sunscreen when you're outside.
• Frequent blood tests to know about the progression of the disease.
• Keep yourself updated through good sources of information such as National Cancer Institute, the American Cancer Society, and The Leukemia & Lymphoma Society.
• Stay connected to family and friends for good support result.
• Join a support group.

There are several risks and complications associated with chronic lymphocytic leukemia.

Risks

• Age: People older than 60 are at higher risk to develop chronic lymphocytic leukemia.
• Sex: Men are at a higher risk than women.
• Race: Whites are more likely than people of other races to develop chronic lymphocytic leukemia.
• Family history of blood and bone marrow cancers: A family history of chronic lymphocytic leukemia or other blood and bone marrow cancers may increase your risk.
• Exposure to chemicals. Certain herbicides and insecticides, including Agent Orange used during the Vietnam War, have been linked to an increased risk of chronic lymphocytic leukemia.

Complications

• Frequent infections: People with chronic lymphocytic leukemia are likely to have recurrent infections especially of the upper and lower respiratory tract. More-serious infections may sometimes prevail.
• Progression to more aggressive cancer: A small number of people with chronic lymphocytic leukemia may develop a more aggressive form of cancer called diffuse large B-cell lymphoma. This switch is also known as Richter's syndrome.
• Increased risk of other cancers: People with chronic lymphocytic leukemia have an increased risk of other types of cancer, including skin cancer, such as melanoma, and cancers of the lung and the digestive tract.
• Immune system problems: A small number of people with chronic lymphocytic leukemia may develop auto-immune condition and antibodies are produced against red blood cells or the platelets.