Leukemia strikes early blood-forming cells, usually the white blood cells, but sometimes it occurs in other types of blood cells. According to the American Cancer Society’s 2018 estimated statistics, there will be about 60,300 new cases of leukemia in the United States in 2018, and about 24,370 deaths will result from this disease. There are several different types of leukemia, such as Acute Lymphocytic Leukemia, Acute Myeloid Leukemia, Chronic Lymphocytic Leukemia, and Chronic Myeloid Leukemia. Each type has its own risk factors, symptoms, and treatment options.
Chronic Lymphocytic Leukemia (CLL)
CLL, which starts in white blood cells found in the bone marrow, accounts for about one-third of all leukemias, and is found mainly in older adults, with the average age of diagnosis being 70. About 20,940 new cases of CLL (about 25% of all types) will be diagnosed in 2018, according the American Cancer Society’s estimated statistics, and about 4,510 deaths will result.
Causes of Chronic Lymphocytic Leukemia
The exact cause of CLL is not known but risk factors include:
- Exposure to certain chemicals (Agent Orange, pesticides)
- Family history (parents, children, and siblings of those with CLL have twice the risk)
- Gender (slightly higher for males)
- Race/ethnicity (higher for North Americans and Europeans)
Symptoms of Chronic Lymphocytic Leukemia
The term “chronic” indicates that these cancer cells build up slowly over time, so symptoms may not be present for several years. CLL is often found through blood tests done for an unrelated health problem or during a routine checkup. The symptoms that do occur are often the symptoms of other conditions; these include the following:
- Weight loss
- Night sweats
- Enlarged lymph nodes
- Pain or sense of fullness in the belly
- Bruising/bleeding (especially nosebleeds and gums)
Diagnosis of Chronic Lymphocytic Leukemia
If a doctor suspects CLL, several steps can be taken to make a diagnosis:
- Medical history and physical exam
- Blood tests
- Bone marrow tests
- Gene tests
- Lymph node biopsy
- Lumbar puncture (spinal tap)
- CT scan
Staging of Chronic Lymphocytic Leukemia
The following stages are from a system called the Rai System, used mostly in the United States:
Stage 0: Lymphocytosis (high number of lymphocytes in the blood and bone marrow not caused by infection or anything else) but no enlargement of the lymph nodes, spleen, and liver. Near normal red blood cell and platelet counts.
Stage 1: Lymphocytosis and enlarged lymph nodes. The spleen and liver are not enlarged, and red blood cell and platelet counts are near normal.
Stage 2: Lymphocytosis and enlarged spleen (and maybe liver), with or without enlarged lymph nodes. Red blood cell and platelet counts are near normal.
Stage 3: Lymphocytosis plus anemia (low red blood cell count), with or without enlarged lymph nodes, spleen, or liver. Platelet counts are near normal.
Stage 4: Lymphocytosis plus thrombocytopenia (low platelet count), with or without anemia, enlarged lymph nodes, spleen, or liver.
Treatment of Chronic Lymphocytic Leukemia
When determining treatment options, doctors separate the stages into risk groups: Stage 0 = low risk, stages 1-2 = intermediate risks, and stages 3-4 = high risk.
Because CLL progresses so slowly, not everyone has to start treatment right away, but when it does start, treatment options include the following:
- Targeted therapy
- Stem cell transplant
- Radiation therapy
- Monoclonal antibodies
Prevention of Chronic Lymphocytic Leukemia
Because there are few known risk factors, and those that are known cannot be changed, there is no way to prevent CLL.