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Chronic Lymphocytic Leukemia Treatment (PDQ®)
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General Information About Chronic Lymphocytic Leukemia
Key Points:
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 the second most common type of leukemia in adults. It often occurs during or after middle age; it rarely occurs in children.
Normally, the body produces bone marrow stem cells (immature cells) that develop into mature blood cells. There are 3 types of mature blood cells:
In CLL, too many stem cells develop into a type of white blood cell called lymphocytes. There are 3 types of lymphocytes:
The lymphocytes in CLL are not able to fight infection very well. Also, as the amount of lymphocytes increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may result in infection, anemia, and easy bleeding.
This summary is about chronic lymphocytic leukemia.
Refer to the following PDQ summaries for more information about leukemia:
- Adult Acute Lymphoblastic Leukemia Treatment.
- Childhood Acute Lymphoblastic Leukemia Treatment.
- Adult Acute Myeloid Leukemia Treatment.
- Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment.
- Chronic Myelogenous Leukemia Treatment.
- Hairy Cell Leukemia Treatment.
Older age can affect the risk
of developing chronic lymphocytic leukemia.
Risk factors for CLL include the following:
- Being middle-aged or older, male, or white.
- A family history of CLL or cancer of the lymph system.
- Having relatives who are Russian Jews or Eastern European Jews.
Possible signs of chronic lymphocytic leukemia include swollen lymph nodes and tiredness.
Usually CLL does not cause any symptoms and is found during a routine blood test. Sometimes symptoms occur that may be caused by CLL or by other
conditions. A doctor should be consulted if any of the following problems
occur:
- 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.
- Weight loss for no known reason.
Tests that examine the blood, bone marrow, and lymph nodes are used to detect
(find) and diagnose chronic lymphocytic leukemia.
The following tests and procedures may be used:
-
Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
-
Complete blood
count (CBC): A procedure in which a sample of blood is drawn and
checked for the following:
- The number of red blood cells, white blood cells, and
platelets.
- The amount of hemoglobin (the protein that carries oxygen) in
the red blood cells.
- The portion of the blood sample made up of red blood
cells.
Complete blood count (CBC); left panel shows blood being drawn from a vein on the inside of the elbow using a tube attached to a syringe; right panel shows a laboratory test tube with blood cells separated into layers: plasma, white blood cells, platelets, and red blood cells.
-
Cytogenetic analysis: A test in which cells in a sample of blood or bone marrow are viewed under a microscope to look for changes in the structure or number of chromosomes in the lymphocytes.
-
Immunophenotyping: A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to find out if malignant lymphocytes (cancer) began from the B lymphocytes or the T lymphocytes.
-
Bone marrow aspiration and biopsy: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views both the bone and bone marrow samples under a microscope to look for abnormal cells.
Certain factors affect treatment options and prognosis (chance
of recovery).
Treatment options depend on:
- The stage of the disease.
- Red blood cell, white blood cell, and platelet blood counts.
- Whether there are symptoms, such as fever, chills, or weight loss.
- Whether the liver, spleen, or lymph nodes are larger than normal.
- The response to initial treatment.
- Whether the CLL has recurred (come back).
The prognosis (chance of recovery) depends on:
- Whether there is a change in the DNA and the type of change, if there is one.
- Whether lymphocytes are spread throughout the bone marrow.
- The stage of the disease.
- Whether the CLL gets better with treatment or has recurred (come back).
- Whether the CLL progresses to lymphoma or prolymphocytic leukemia.
- The patient's general health.
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Stages of Chronic Lymphocytic Leukemia
Key Points:
After chronic lymphocytic leukemia has been diagnosed, tests
are done to find out how far the cancer has spread in the blood and bone marrow.
Staging is the process used to find out how far the cancer has spread. It is important to know the stage of the disease in order to plan the best treatment. The following tests may be used in the staging process:
-
Bone marrow aspiration and biopsy: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views both the bone and bone marrow samples under a microscope to look for abnormal cells.
-
Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body, such as the lymph nodes.
-
MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the brain and spinal cord. This procedure is also called nuclear magnetic resonance imaging (NMRI).
-
CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
-
Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
-
Antiglobulin test: A test in which a sample of blood is looked at under a microscope to find out if there are any antibodies on the surface of red blood cells or platelets. These antibodies may react with and destroy the red blood cells and platelets. This test is also called a Coomb's test.
The following stages are used for chronic lymphocytic
leukemia:
Stage 0
In stage 0 chronic lymphocytic leukemia, there are too many
lymphocytes in the blood, but there are no other symptoms of leukemia.
Stage 0 chronic lymphocytic leukemia is indolent
(slow-growing).
Stage I
In stage I chronic lymphocytic leukemia, there
are too many lymphocytes in the blood and the lymph nodes are larger than normal.
Stage II
In stage II chronic lymphocytic leukemia, there
are too many lymphocytes in the blood, the liver or spleen
is larger than normal, and the lymph nodes may be larger than normal.
Stage III
In stage III chronic lymphocytic leukemia,
there are too many lymphocytes in the blood and there are too few red blood
cells. The lymph nodes, liver, or spleen may be larger than normal.
Stage IV
In stage IV chronic lymphocytic leukemia, there
are too many lymphocytes in the blood and too few platelets. The lymph nodes, liver, or spleen may be larger than normal
and there may be too few red blood cells.
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Refractory Chronic Lymphocytic Leukemia
Refractory chronic lymphocytic leukemia is cancer that does not get better with treatment.
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Treatment Option Overview
Key Points:
There are different types of treatment for patients with
chronic lymphocytic leukemia.
Different types of treatment are available for patients with chronic lymphocytic leukemia.
Some treatments are standard (the currently used treatment), and some are being
tested in clinical trials. Before
starting treatment, patients may want to think about taking part in a clinical
trial. A treatment clinical trial is a research study meant to help improve
current treatments or obtain information on new treatments for patients with
cancer. When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from the
NCI Web
site. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care
team.
Five types of standard treatment are used:
Watchful waiting
Watchful waiting
is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change. This is also called observation. During this time, problems caused by the disease, such as infection, are treated.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, or the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Surgery
Splenectomy is surgery to remove the spleen.
Monoclonal antibody therapy
Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances in the body that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
New types of treatment are being tested in clinical trials.
These include the following:
Chemotherapy with stem cell transplant
Chemotherapy with stem cell transplant is a method of giving chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web
site.
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Treatment Options by Stage
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Stage 0 Chronic Lymphocytic Leukemia
Treatment of stage 0 chronic lymphocytic leukemia is usually watchful waiting.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage 0 chronic lymphocytic leukemia.
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Stage I, Stage II, Stage III, and Stage IV Chronic Lymphocytic Leukemia
Treatment of stage I, stage II, stage III, and stage IV chronic lymphocytic leukemia may include the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web
site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I chronic lymphocytic leukemia, stage II chronic lymphocytic leukemia, stage III chronic lymphocytic leukemia and stage IV chronic lymphocytic leukemia.
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Treatment Options for Refractory Chronic Lymphocytic
Leukemia
Treatment of refractory chronic lymphocytic leukemia may include the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web
site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with refractory chronic lymphocytic leukemia.
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Changes to This Summary (09/24/2007)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Images were added to this summary.
This information is provided from the PDQ® database in collaboration with the NCI.
Educational Materials
Chronic Lymphocytic Leukemia (CLL) is the most common form of leukemia among adults in the Western Hemisphere. It is a widely variant disease that primarily affects the elderly. Although CLL is incurable, many patients can successfully manage the disease for a number of years with the help of innovative medical treatment (the five-year relative survival rate is 74 percent). Having a full understanding of CLL and choosing an expert medical team are vital for successful management of this disease. The Web links displayed below offer an abundance of easily understandable information about CLL research, treatment and survival issues from experts who collaboratively study and treat this disease at the OSU Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Johns Hopkins University, and the University of Southampton in the United Kingdom.
The first two links for each presentation contain streaming video and will be able to play without downloading the entire presentation. The video contained in the presentations utilizes Windows Media Viewer and is synchronized to the PowerPoint. If you have trouble viewing the presentations with video, please use the "PowerPoint Presentation without video" or the "Word Document of Presentation" link avialable with each presentation set.
The following presentations were part of the "Trends in Treating Chronic Lymphocytic Leukemia" conference that was sponsored by The Leukemia & Lymphoma Society on April 16, 2004 in collaboration with the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, and supported by unrestricted educational grants from Berlex, Genentech and Biogen IDEC.
Old and New Treatments For CLL - Dr. John C. Byrd, M.D.
Evolving BMT and Immunotherapy Treatment Paradigms For Patients With CLL - Ian W. Flinn, M.D., Ph.D
Importance of Clinical Research - Michael R. Grever, M.D.
New Prognostic Indicators for CLL - Terry Hamblin, M.D.
Survivorship Issues for CLL Patients - Mollie Moran, MSN, CNP
For copies of these presentations on CDRom, contact:
Kathy Cox, LISW
Patient Services Manager
The Leukemia & Lymphoma Society, Central Ohio Chapter
(800) 686-2873
coxk@lls.org
