Chronic
Lymphocytic Leukemia (CLL)Symptoms: Usually the
patient with CLL will not have any symptoms for some time. The first sign may
be that a loved one or the patient notices a swollen
lymph gland that is painless. This often prompts a doctor's office
visit. The doctor will confirm that lump and may even find an enlarged liver and
an enlarged spleen. A blood screening test will point to the diagnoses of
CLL. Later the patient will get lack of appetite and rapid weight loss, fatigue
and shortness of breath. Later-on
with progressive disease there will be a generalized lymph gland swelling (lymphadenopathy)
and abdominal fullness from liver and spleen enlargement and abdominal lymphadenopathy.
A late sign is a proneness to bacterial infections, viral infections and fungal
infections because antibodies are missing (hypogammaglobulinemia) and there is
a low white blood cell count (granulocytopenia). This all is due to the overabundance
of abnormal lymphocytes. They are look-alikes, but have no function other than
to destroy the other blood cell types thus producing the symptoms of this particular
blood cancer, CLL. Tests: Blood tests show a sustained absolute
lymphocyte count of more than 5,000 per micro liter. At the same time there are
more
than 30% lymphocytes in the bone marrow. In some patients there is a low
antibody count (hypogammaglobulinemia). The B-cell type CLL has B cell surface
markers, which can be determined through immunotyping. Staging:
There is a popular staging system in North America, which has been very useful
in comparing the results from one institution to the next. The Rai classification
employs five stages from 0 to IV as follows (modified from Ref.1):
| Chronic
lymphocytic leukemia (CLL) |
| Rai classification:
| Details
of classification: | | Stage
0 | absolute lymphocyte
count in blood more than 10,000 per microliter and more than 30% lymphocytes
in bone marrow | | stage
I | like in stage 0 and
enlarged lymph glands | | stage
II | stage I and spleen
and liver enlargement | | stage
III | stage II and anemia
with hemoglobin of less than 11g per deciliter |
| stage IV | stage
III and low platelet count (less than 100,000 per microliter) |
Chronic lymphocytic leukemia treatment: Not
every case of CLL has to be treated. Patients with CLL have a very good overall
survival chance. B-cell CLL has an overall survival of 50% over 10 years without
any treatment. However, there are tremendous differences in survival between
the various Rai stages. For instance, patients in stage 0 to II of the Rai
classification will live 5 to 20 years, with stage 0 being the better survival.
Patients with stage II or IV will only live on average another 3 to 4 years. When
bone marrow failure is evident( the worst among stage IV), survival may only be
weeks or a few months. Unfortunately the weakness of the immune system that is
associated with a more advanced stage of CLL leads to secondary cancers, which
have a major impact on the overall survival. Chemotherapy: When
treatment is felt to be necessary, the proven combination has been and still is
chlorambucil as well as corticosteroids. The hematologist has to individualize
the therapy. Care has to be taken that over treatment does not kill the patient.
Basically the goal of chemotherapy is to bring CLL into remission and hope that
the relatively benign underlying course returns. Corticosteroid
therapy: When hemolytic anemia or thrombocytopenia (low platelet
counts) are setting in as a complication of CLL, then it is time to treat this
with corticosteroids. However, serious side effects from prolonged use have to
be avoided. Radiotherapy: Occasionally local
radiation is given to areas of lymph gland swelling or liver and spleen enlargement.
This is usually only used as a palliative care as serious long-term side effects
are known to occur with radiotherapy. | 
