Get the Facts on Chronic Lymphocytic Leukemia

Get the Facts on Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell). Chronic lymphocytic leukemia (also called CLL) is a blood and bone marrow disease that usually gets worse slowly. CLL is one of the most common types of leukemia in adults. It often occurs during or after middle age; it rarely occurs in children. 

How Leukemia Affects Blood Cells

Leukemia may affect red blood cells, white blood cells, and platelets. Normally, the body makes blood stem cells (immature cells) that become mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell.

A myeloid stem cell becomes one of three types of mature blood cells:
Red blood cells that carry oxygen and other substances to all tissues of the body
White blood cells that fight infection and disease 
Platelets that form blood clots to stop bleeding

CLL is one of the most common types of leukemia in adults. It often occurs during or after middle age.

A lymphoid stem cell becomes a lymphoblast cell and then one of three types of lymphocytes (white blood cells):
B lymphocytes that make antibodies to help fight infection
T lymphocytes that help B lymphocytes make antibodies to fight infection
Natural killer cells that attack cancer cells and viruses

In CLL, too many blood stem cells become abnormal lymphocytes. The abnormal lymphocytes may also be called leukemia cells. The lymphocytes are not able to fight infection very well. Also, as the number of abnormal lymphocytes increases in the blood and bone marrow, there is less room for red blood cells and platelets. This may cause anemia and easy bleeding.

Signs & Symptoms of CLL

Signs and symptoms of chronic lymphocytic leukemia include swollen lymph nodes and tiredness. In the beginning, CLL does not cause any signs or symptoms and may be found during a routine blood test. Later, signs and symptoms may occur.

Check with your doctor if you have any of the following:
• Painless swelling of the lymph nodes in the neck, underarm, stomach, or groin
• Feeling very tired
• Pain or fullness below the ribs
• Fever and infection
• Easy bruising or bleeding
• Petechiae (flat, pinpoint, dark-red spots under the skin caused by bleeding) 
• Weight loss for no known reason.

Treating CLL

Certain factors affect your CLL treatment options and prognosis, or chance of recovery. Treatment options depend on the following:
• Your red blood cell, white blood cell, and platelet blood counts
• Whether your liver, spleen, or lymph nodes are larger than normal
• Whether there are signs or symptoms, such as fever, chills, or weight loss
• Your response to initial treatment
• Whether the CLL has recurred, or come back

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Did You Know?
Anatomy of the Bone 

The bone is made up of compact bone, spongy bone, and bone marrow. Compact bone makes up the outer layer of the bone. Spongy bone is found mostly at the ends of bones and contains red marrow. Bone marrow is found in the center of most bones and has many blood vessels. There are two types of bone marrow: red and yellow. Red marrow contains blood stem cells that can become red blood cells, white blood cells, or platelets. Yellow marrow is made mostly of fat.

The prognosis depends on the following:
• Whether there are certain gene changes, such as the IgVH mutation
• Whether lymphocytes have spread throughout the bone marrow 
• Your red blood cell, white blood cell, and platelet blood counts
• Whether your liver, spleen, or lymph nodes are larger than normal
• The results of certain blood tests, such as the beta-2 microglobulin test
• Your age and general health
• Whether your CLL gets better with treatment or has recurred (come back)
• Whether the CLL progresses to lymphoma or becomes prolymphocytic leukemia

Chronic lymphocytic leukemia is described as asymptomatic, symptomatic or progressive, refractory, or recurrent. In asymptomatic CLL, the leukemia causes no or few symptoms. With symptomatic or progressive CLL, the leukemia has caused significant changes to blood counts or other serious symptoms. With recurrent CLL, the leukemia has recurred, or come back, after a period of time in which the cancer could not be detected. In people with refractory CLL, the leukemia does not get better with treatment.

After chronic lymphocytic leukemia has been diagnosed, tests are done to find out whether the cancer has spread. Staging is the process used to find out how far the cancer has spread. In chronic lymphocytic leukemia, the leukemia cells may spread from the blood and bone marrow to other parts of the body, such as the lymph nodes, liver, and spleen. It is important to know whether the leukemia cells have spread in order to plan the best treatment.

Source: National Cancer Institute,

This article was published in Coping® with Cancer magazine, January/February 2020.