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Chronic lymphocytic leukemia


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is chronic lymphocytic leukemia?
STAGE EXPLANATION
Stages of chronic lymphocytic leukemia
Stage 0
Stage I
Stage II
Stage III
Stage IV
Refractory
TREATMENT OPTION OVERVIEW
How chronic lymphocytic leukemia is treated
Treatment by stage
STAGE 0 CHRONIC LYMPHOCYTIC LEUKEMIA
STAGE I CHRONIC LYMPHOCYTIC LEUKEMIA
STAGE II CHRONIC LYMPHOCYTIC LEUKEMIA
STAGE III CHRONIC LYMPHOCYTIC LEUKEMIA
STAGE IV CHRONIC LYMPHOCYTIC LEUKEMIA
REFRACTORY CHRONIC LYMPHOCYTIC LEUKEMIA
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that gives up-to-date information on cancer and its prevention, detection, treatment, and supportive care. It is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your doctor, who knows you and has the facts about your disease. PDQ can also provide the names of additional health care professionals who specialize in treating patients with cancer.

Before you start treatment, you also may want to think about taking part in a clinical trial. PDQ can be used to learn more about these trials. A clinical trial is a research study that attempts to improve current treatments or finds information on new treatments for patients with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help patients with cancer. Information is collected about new treatments, their risks, and how well they do or do not work. When clinical trials show that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the standard treatment. Listings of current clinical trials are available on PDQ. Many cancer doctors who take part in clinical trials are listed in PDQ.

To learn more about cancer and how it is treated, or to learn more about clinical trials for your kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is chronic lymphocytic leukemia?

Chronic lymphocytic leukemia (CLL) is a disease in which too many infection-fighting white blood cells called lymphocytes are found in the body. Lymphocytes are made in the bone marrow and by other organs of the lymph system. The bone marrow is the spongy tissue inside the large bones in the body. The bone marrow makes red blood cells (which carry oxygen and other materials to all tissues of the body), white blood cells (which fight infection), and platelets (which make the blood clot). Normally, bone marrow cells called blasts develop (mature) into several different types of blood cells that have specific jobs to do in the body.

The lymph system is made up of thin tubes that branch, like blood vessels, into all parts of the body. Lymph vessels carry lymph, a colorless, watery fluid that contains lymphocytes. Along the network of vessels are groups of small, bean-shaped organs called lymph nodes. Clusters of lymph nodes are found in the underarm, pelvis, neck, and abdomen. The spleen (an organ in the upper abdomen that makes lymphocytes and filters old blood cells from the blood), the thymus (a small organ beneath the breastbone), and the tonsils (an organ in the throat) are also part of the lymph system.

Lymphocytes fight infection by making substances called antibodies, which attack germs and other harmful things in the body. In CLL, the developing lymphocytes do not mature correctly and too many are made. The lymphocytes may look normal, but they cannot fight infection as well as they should. These immature lymphocytes are then found in the blood and the bone marrow. They also collect in the lymph tissues and make them swell. Lymphocytes may crowd out other blood cells in the blood and bone marrow. Anemia may develop if the bone marrow cannot make enough red blood cells to carry oxygen. If the bone marrow cannot make enough platelets to make the blood clot normally, bleeding or bruising may occur easily.

Leukemia can be acute (progressing quickly with many immature cells) or chronic (progressing slowly with more mature, normal-looking cells). Chronic lymphocytic leukemia progresses slowly and usually occurs in people 60 years of age or older. In the first stages of the disease there are often no symptoms. As time goes on, more and more lymphocytes are made and symptoms begin to appear. A doctor should be seen if the lymph nodes swell, the spleen or liver becomes larger than normal, a feeling of fatigue persists, or bleeding occurs easily.

If there are symptoms, a doctor will do a physical examination and may order blood tests to count the number of each of the different kinds of blood cells. More blood tests may be done if the results of the blood tests are not normal. The doctor also may do a bone marrow biopsy. During this test, a needle is inserted into a bone and a small amount of bone marrow is taken out and looked at under the microscope. The doctor can then tell what kind of leukemia the patient has and plan the best treatment.

The chance of recovery (prognosis) depends on the stage of the disease, and the patient's age and general health.

There are separate PDQ patient information summaries on acute lymphocytic leukemia (adult and childhood), acute myeloid leukemia (adult and childhood), chronic myelogenous leukemia, and hairy cell leukemia.


STAGE EXPLANATION


Stages of chronic lymphocytic leukemia

Once chronic lymphocytic leukemia has been found (diagnosed), more tests may be done to find out if leukemia cells have spread to other parts of the body. This is called staging. A doctor needs to know the stage of the disease to plan treatment. The following stages are used for chronic lymphocytic leukemia:


Stage 0

There are too many lymphocytes in the blood, but there are usually no other symptoms of leukemia. Lymph nodes and the spleen and liver are not swollen and the number of red blood cells and platelets is normal.


Stage I

There are too many lymphocytes in the blood and lymph nodes are swollen. The spleen and liver are not swollen and the number of blood cells and platelets is normal.


Stage II

There are too many lymphocytes in the blood and lymph nodes and the liver and spleen are swollen.


Stage III

There are too many lymphocytes in the blood and there are too few red blood cells (anemia). Lymph nodes and the liver or spleen may be swollen.


Stage IV

There are too many lymphocytes in the blood and too few platelets, which make it hard for the blood to clot. The lymph nodes, liver, or spleen may be swollen and there may be too few red blood cells (anemia).


Refractory

Refractory means that the leukemia does not respond to treatment.


TREATMENT OPTION OVERVIEW


How chronic lymphocytic leukemia is treated

There are treatments for all patients with chronic lymphocytic leukemia. Three kinds of treatment are used:

chemotherapy (using drugs to kill cancer cells)
radiation therapy (using high-dose x-rays or other high-energy rays to kill
cancer cells)
treatment for complications of the leukemia, such as infection.

The use of biological therapy (using the body's immune system to fight cancer) is being tested in clinical trials. Surgery may be used in certain cases.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in the vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for CLL usually comes from a machine outside the body (external radiation therapy).

If the spleen is swollen, a doctor may take out the spleen in an operation called a splenectomy. This is only done in rare cases.

Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

Because infection often occurs in patients with CLL, a special substance called immunoglobulin, which contains antibodies, may be given to prevent infections.

Sometimes a special machine is used to filter the blood to take out extra lymphocytes. This is called leukapheresis.

Bone marrow transplantation is used to replace the bone marrow with healthy bone marrow. First, all of the bone marrow in the body is destroyed with high doses of chemotherapy with or without radiation therapy. Healthy marrow is then taken from another person (a donor) whose tissue is the same as or almost the same as the patient's. The donor may be a twin (the best match), a brother or sister, or another person not related. The healthy marrow from the donor is given to the patient through a needle in the vein, and the marrow replaces the marrow that was destroyed. A bone marrow transplant using marrow from a relative or person not related to the patient is called an allogeneic bone marrow transplant.

Another type of bone marrow transplant, called autologous bone marrow transplant, is being studied in clinical trials. To do this type of transplant, bone marrow is taken from the patient and treated with drugs to kill any cancer cells. The marrow is frozen to save it. Next, the patient is given high-dose chemotherapy with or without radiation therapy to destroy all of the remaining marrow. The frozen marrow that was saved is then thawed and given back to the patient through a needle in a vein to replace the marrow that was destroyed.


Treatment by stage

Treatment of chronic lymphocytic leukemia depends on the stage of the disease, and the patient's age and overall health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Most patients with chronic lymphocytic leukemia are not cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are on going in most parts of the country for most stages of chronic lymphocytic leukemia. To know more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


STAGE 0 CHRONIC LYMPHOCYTIC LEUKEMIA

If the patient has stage 0 CLL, treatment may not be needed or chemotherapy may be given. A doctor will follow the patient closely so treatment can be started if the leukemia gets worse.


STAGE I CHRONIC LYMPHOCYTIC LEUKEMIA

Treatment may be one of the following:

1. If there are no symptoms, no treatment may be needed. A doctor will follow the patient closely so treatment can be started if the leukemia gets worse.

2. Chemotherapy with or without steroids.

3. Other chemotherapy drugs.

4. External radiation therapy to swollen lymph nodes.


STAGE II CHRONIC LYMPHOCYTIC LEUKEMIA

Treatment may be one of the following:

1. If there are few or no symptoms, no treatment may be needed. A doctor will follow the patient closely so treatment can be started if the leukemia gets worse.

2. Chemotherapy with or without steroids.

3. Clinical trials of biological therapy.

4. External radiation therapy to the spleen to reduce symptoms caused by the enlargement of the spleen.


STAGE III CHRONIC LYMPHOCYTIC LEUKEMIA

Treatment may be one of the following:

1. Chemotherapy with or without steroids.

2. Other chemotherapy drugs.

3. Combination chemotherapy.

4. Clinical trials of bone marrow transplantation.

5. Surgery to remove the spleen (splenectomy).

6. A clinical trial evaluating biological therapy.


STAGE IV CHRONIC LYMPHOCYTIC LEUKEMIA

Treatment may be one of the following:

1. Chemotherapy.

2. Clinical trials of bone marrow transplantation.

3. Surgery to remove the spleen (splenectomy).

4. External radiation therapy to the spleen.

5. External radiation therapy to the whole body (whole body radiation).

6. Clinical trials of biological therapy.


REFRACTORY CHRONIC LYMPHOCYTIC LEUKEMIA

Treatment depends on many factors; patients may wish to consider entering a clinical trial of new chemotherapy drugs and bone marrow transplantation.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about chronic lymphocytic leukemia, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, trained information specialists can answer your questions.

The Cancer Information Service also has booklets that are available to the public and can be sent on request. The following booklets about leukemia may be helpful:

What You Need To Know About Leukemia
Research Report: Bone Marrow Transplantation

The following general booklets on questions related to cancer may also be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where people can get materials and information about cancer treatment and services. The social service office at a hospital can be checked for local and national agencies that help with getting information about finances, getting to and from treatment, getting care at home, and dealing with problems.

For more information from the National Cancer Institute, please write to this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 06/1999


If you want to know more about cancer and how it is treated, or if you wish to know about clinical trials for your type of cancer, you can call the NCI's Cancer Information Service at 1-800-422-6237, toll free. A trained information specialist can talk with you and answer your questions.


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