Chronic Lymphotic Leukemia

Chronic lymphocytic leukemia (CLL) is one of the four basic types of leukemia. It most commonly affects adults and rarely occurs in children.

Causes

CLL comes from white blood cells belonging to group of B lymphocytes. These white blood cells are an important part of immune system because of antibodies production. The affected cell suffers from a chromosomal disorder or a genetic mutation that result in change of its attributes and the loss of ability to respond to control mechanisms. This leads to an uncontrolled multiplication and spread of malignant cell clones throughout the body. The exact reason of the mutation and subsequent cell conversion in CLL is not known, it is probably a combination of inner and outer factors.

Symptoms

Tumor cells settle in the bone marrow, lymph nodes and organs of the body. Malignant white blood cells are immature and can not fully perform their functions. Furthermore, tumor clones suppress the formation of other blood cells (healthy white blood cells, red blood cells) and platelets in the bone marrow. The disease can be asymptomatic but usually classic leukemic signs occur such as fatigue, fever, night sweats, joint pain, loss of appetite, weight loss, etc.


Other symptoms depend on infestation of certain tissues by tumor cells (painless enlarged lymph nodes, enlarged liver and enlarged spleen) and deficiency of blood cells and platelets. The lack of red blood cells manifests by anemia and anemic syndrome. Insufficient production of white blood cells results in immunodeficiency and recurring infections. Platelet production disorder causes increased tendency to bleed (for example bruising). The disease may progress at different speeds. Some forms can kill the patient in a few years without proper treatment; other forms persist for decades with no or only mild symptoms.

Diagnosis

CLL can be either diagnosed from the above mentioned symptoms or it is randomly found in a blood count with unreasonably high numbers of lymphocytes. Blood count is important but more examinations need to be done to determine the right diagnosis. Hematologists can examine the white blood cells and confirm that they are clones of one tumor cell. It is important to obtain a sample of bone marrow cells (by sternal puncture) or a sample of bone marrow tissue (trephine biopsy, usually from the iliac crest). Cytogenetic and molecular genetic methods can give us more information about cancer cells, allow us to estimate prognosis and determine the best therapeutic approach. Imaging methods such as chest X-ray, ultrasound and computed tomography are important in determining the extent of the tumor spread.

Treatment

Before the treatment itself it is essential to properly diagnose the disease and individually evaluate its extent and prognosis. Early stages are often only monitored as the therapy may be an unnecessary burden to the organism without adequate benefits. The patients are regularly monitored by hematologists and the treatment begins in later stages. As with most leukemias, chemotherapy is the basic method of treatment in CLL. There are used different chemotherapeutic agents and their combinations. CLL is also cured by modern biological treatment that in this case consists of administration of antibodies targeting cell surface of malignant cells.

 

Bone marrow transplantation is a therapeutic method less usually used in CLL and it is reserved for cases with no other effective treatment option. It is a risky procedure that simply put means killing cancer cells (and the whole bone marrow of the patient) using powerful chemotherapy and radiation. Subsequently, the patient gets the bone marrow of a donor. In ideal case, the healthy cells of the bone marrow spread throughout the body and inhabit bone marrow destroyed by previous stage of treatment. If the new cells are not competent enough, or if an infection occurs during the procedure, the consequences can be fatal.