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Leukemia (Chronic Lymphocytic)

Chronic Lymphocytic Leukemia

What is chronic lymphocytic leukemia? — Chronic lymphocytic leukemia, called "CLL," is a type of blood cancer that usually grows very slowly.
Blood is made up of different types of cells. These cells are made in the center of your bones, in a part called the bone marrow. When people have CLL, their bone marrow makes abnormal blood cells. These abnormal blood cells grow out of control, get into the blood, and travel around the body. Sometimes, these cells collect in certain parts of the body.
When the bone marrow makes abnormal blood cells, it does not make enough of the normal blood cells a person's body needs. This can cause symptoms.
What are the symptoms of CLL? — CLL does not usually cause symptoms when it is in the early stages, and people might not know that they have it. Many times, people are diagnosed after having routine blood tests.
When CLL does cause symptoms, the most common ones are:
Feeling very tired and weak
Swollen lymph nodes in the neck, under the arm, or in the groin – Lymph nodes are bean-shaped organs that are part of the body's infection-fighting system.
Getting sick from infections more easily than normal
Fevers, drenching sweats at night, and losing weight without trying to
Is there a test for CLL? — Yes. Your doctor or nurse will talk with you, do an exam, and do blood tests. He or she might also do a bone marrow biopsy. For this test, a doctor takes a very small sample of the bone marrow. Then another doctor will look at the cells under a microscope to see if abnormal (cancer) cells are present.
How is CLL treated? — Doctors can treat CLL in different ways. Sometimes, doctors do not treat CLL right away. Your doctor might not treat your CLL right away if it is slow-growing and not causing any symptoms. But your doctor will watch your CLL closely by doing exams and blood tests until treatment is needed.
CLL is usually treated if it is causing symptoms or growing fast. Treatment might involve 1 or more of the following:
Targeted therapy – These are medicines that work only for cancers with certain characteristics. One example is a medicine called ibrutinib (brand name: Imbruvica). Most people who need treatment for CLL get this medicine first.
Antibodies – Antibodies are proteins in your blood. Your immune system makes them to help your body fight infections. But there are other types of antibodies that are created in a lab and used as medicine. They kill cancer cells by targeting specific parts of the cells.
Chemotherapy – Chemotherapy is the medical term for medicines that kill cancer cells or stop them from growing.
People with CLL can get sick from infections more easily than normal. Because of this, it's important to wash your hands often and stay away from people who are sick. Let your doctor or nurse know right away if you get a fever.
What happens after starting treatment? — After you begin treatment, your doctor will check you every so often. This is to see if the cancer is getting better, staying the same, or getting worse. It involves regular appointments to talk with your doctor and get exams and blood tests. Sometimes, your doctor will also do a bone marrow biopsy.
What happens if the CLL gets worse or comes back? — If your CLL gets worse or comes back, your doctor will talk with you about other possible treatments. Treatment might involve 1 or more of the following:
Targeted therapy – There are several types of targeted therapy. Most people whose CLL comes back after treatment will get 1 of these medicines.
Chemotherapy – You might get the same medicines that you got before, or you might get different ones.
Bone marrow transplant (also called "stem cell transplant") – This treatment replaces cells in the bone marrow that are killed by chemotherapy or radiation. These "donor" cells come from another person whose blood matches yours.
Treatments to reduce symptoms – For example, your doctor can give you medicines to help reduce the number of infections that you get.
What else should I do? — It's important to follow all your doctor's instructions about visits and tests. It's also important to talk to your doctor about any side effects or problems you have during treatment.
Getting treated for CLL involves making many choices, such as what treatment to have and when.
Always let your doctors and nurses know how you feel about a treatment. Any time you are offered a treatment, ask:
What are the benefits of this treatment? Is it likely to help me live longer? Will it reduce or prevent symptoms?
What are the downsides to this treatment?
Are there other options besides this treatment?
What happens if I do not have this treatment?
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 15791 Version 13.0
Release: 28.2.2 - C28.105
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