Alternate Names: CLL

Causes and Risks: Chronic lymphocytic leukemia (CLL) affects the B lymphocytes and causes immunosuppression, failure of the bone marrow, and infiltration of malignant (cancerous) cells into organs. Usually the symptoms and the course of the disease will develop gradually. The incidence is approximately 2 per 100,000 and increases with age, 90% of cases are found in people over 50 years old. Many cases are detected by routine blood tests in people with no symptoms. The cause of CLL is unknown. No relationship to radiation, carcinogenic chemicals, or viruses has been determined. The disease is more common in Jewish people of Russian or Eastern European descent and is uncommon in the far east.

Prevention: There is no known way to prevent this disorder.

Symptoms:

• enlarged lymph nodes, liver, or spleen
• fatigue
• abnormal bruising (occurs late in the disease)
• sweating, excessive -- night sweats
• loss of appetite
• weight loss

Signs and Tests:

• elevated white blood cell count in a CBC
• flow cytometry revealing an abnormal population of white blood cells.
• bone marrow aspiration

• Serum Protein Electrophoresis

Treatment: Early stage disease often requires no specific therapy (since early therapy does not improve survival), but close observation is important. Chemotherapy may be indicated for fatigue, anemia, thrombocytopenia, or enlarged lymph nodes that are troublesome. Standard first line chemotherapy usually includes the drug fludarabine. Other drugs that may be used in this disease include chlorambucil and cytoxan. Recently, the drug Campath, which is an antibody targeted to proteins on the surface of CLL cells, has been approved for treatment of patients with CLL who have failed fludarabine. Another antibody drug (Rituxan) may also be used. Rarely, radiation may be used for enlarged lymph nodes. Blood transfusions or platelet transfusions may be required.

Prognosis: Prognosis depends on the stage of the disease. For patients with the earliest stages of the disease, half of patients live more than 12 years whereas for the more advanced stages, half of patients may die within 2 years.

Complications:

• increased risk of second malignancies
• side effects of chemotherapy
• bleeding from low platelets
• fatigue from anemia
• autoimmune hemolytic anemia
• Idiopathic Thrombocytopenic Purpura (ITP)
• hypogammaglobulinemia (reduced levels of antibodies) with increased susceptibility to infection

Call for an appointment with your health care provider if symptoms occur that are suggestive of CLL.