What is CLL Chronic lymphocytic leukemia

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Chronic lymphocytic leukemia (CLL) is a type of blood cancer that begins in the bone marrow. It can progress either slowly or quickly depending on the form it takes. Many people with CLL live good-quality lives for years with medical care.

Chronic lymphocytic leukemia (CLL) results from an acquired (not present at birth) change (mutation) to the DNA of a single marrow cell that develops into a lymphocyte. In 95 percent of people with CLL, the change occurs in a B lymphocyte. In the other 5 percent of people with CLL, the cell that transforms from normal to leukemic has the features of a T lymphocyte or an NK cell. Thus, any of the three major types of lymphocytes (T cells, B cells or NK cells) can undergo a malignant transformation that causes diseases related to B-cell CLL.

Who is likely to get it

An estimated 85,713 people are living with CLL, and 15,490 people are expected to be diagnosed with CLL in the United States in 2009. Physicians have learned a great deal in the last few decades about CLL. In the last several years, new therapies have been developed, and outcomes for people living with CLL are steadily improving.


Causes and Risk Factors. CLL has generally not been associated with any environmental or external factors. However, the Institute of Medicine of the National Academy of Sciences issued a report “Veterans and Agent Orange: Update 2002,” which concluded that there was “sufficient evidence of an association” between herbicides used in Vietnam and CLL. For more information from the US Department of Veterans Affairs see www1.va.gov/AgentOrange or call (800) 827-1000.

First-degree relatives of patients with CLL are three to four times more likely to develop CLL than people who do not have first-degree relatives with the disease. However, the risk is still small. For example, the 60-year-old sibling or child of someone with CLL would have three to four chances in 10,000 of developing the disease, compared with the one chance in 10,000 for a 60-year-old person without a family history of the disease.


Symtoms and signs

CLL symptoms usually develop over time. Early in the course of the disease, CLL often has little effect on a person’s well-being. Some people with CLL do not have any symptoms. The disease may be suspected because of abnormal results from  blood tests that were ordered either as part of an annual physical or a medical examination for an unrelated condition. An elevated white cell (lymphocyte) countis the most common finding that leads a physician to consider a CLL diagnosis.

People with CLL who do have symptoms may tire more easily, and/or may feel short of breath during day-to-day physical activities—as a result of anemia (low red cell count). They may lose weight because of decreased appetite and/or increased use of energy. The lymph nodes and spleen may become enlarged as a result of an accumulation of CLL cells (leukemic lymphocytes). Infections of the skin, lungs, kidneys or other sites may occur as result of low immunoglobulin levels and decreased neutrophil counts.

What are the treatment options

Current therapies do not offer patients a cure for CLL, but there are treatments that help manage the disease. Treatments for CLL include

• Watch and wait

• Single or combination drug therapy

• Blood cell growth factors

• Radiation therapy

• Splenectomy

The removal of the spleen

• Treatment in a clinical trial

– Drug therapy with new drugs or new drug combinations

– High-dose chemotherapy and allogeneic stem cell transplantation.


The goals of CLL treatments are to

• Slow the growth of the CLL cells

• Provide long periods of remission (when there are no signs of CLL and/or people feel well enough to go about their day-to-day activities)

• Help people to feel better if they have infections, fatigue or other symptoms

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