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Chronic Lymphocytic Leukemia Library

Learn about Chronic Lymphocytic Leukemia

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 one of the most common types of leukemia in adults. It often occurs during or after middle age; it rarely occurs in children.

Leukemia may affect red blood cells, white blood cells, and platelets.

Normally, the body makes blood stem cells (immature cells) that become mature blood cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell.

A myeloid stem cell becomes one of three types of mature blood cells:

  • Red blood cells that carry oxygen and other substances to all tissues of the body.
  • White blood cells that fight infection and disease.
  • Platelets that form blood clots to stop bleeding.

A lymphoid stem cell becomes a lymphoblast cell and then one of three types of lymphocytes (white blood cells):

  • B lymphocytes that make antibodies to help fight infection.
  • T lymphocytes that help B lymphocytes make antibodies to fight infection.
  • Natural killer cells that attack cancer cells and viruses.

In CLL, too many blood stem cells become abnormal lymphocytes. The abnormal lymphocytes may also be called leukemia cells. The lymphocytes are not able to fight infection very well. Also, as the number of abnormal lymphocytes increases in the blood and bone marrow, there is less room for red blood cells and platelets. This may cause anemia and easy bleeding.

This summary is about chronic lymphocytic leukemia. See the following PDQ summaries for more information about other types of leukemia:

Signs and symptoms of chronic lymphocytic leukemia include swollen lymph nodes and tiredness.

In the beginning, CLL does not cause any signs or symptoms and may be found during a routine blood test. Later, signs and symptoms may occur.

Check with your doctor if you have any of the following:

  • 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.
  • Easy bruising or bleeding.
  • Petechiae (flat, pinpoint, dark-red spots under the skin caused by bleeding).
  • Weight loss for no known reason.

Tests that examine the blood are used to diagnose chronic lymphocytic leukemia.

The following tests and procedures may be used:

  • Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as enlarged lymph nodes 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) with differential: A procedure in which a sample of blood is drawn and checked for the following:
    • The number of red blood cells and platelets.
    • The number and type of white blood cells.
    • 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.
  • 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.
  • Lactate dehydrogenase testing: A laboratory test for one of a group of enzymes found in the blood and other body tissues and involved in energy production in cells. An increased amount of lactate dehydrogenase in the blood may be a sign of tissue damage and some types of cancer or other diseases.
  • Beta-2-microglobulin testing: A laboratory test for beta-2-microglobulin, a small protein normally found on the surface of many cells, including lymphocytes, and in small amounts in the blood and urine. An increased amount in the blood or urine may be a sign of certain diseases, including some types of cancer, such as multiple myeloma or lymphoma.
  • Flow cytometry: A laboratory test that measures the number of cells in a sample, the percentage of live cells in a sample, and certain characteristics of the cells, such as size, shape, and the presence of tumor (or other) markers on the cell surface. The cells from a sample of a patient’s blood, bone marrow, or other tissue are stained with a fluorescent dye, placed in a fluid, and then passed one at a time through a beam of light. The test results are based on how the cells that were stained with the fluorescent dye react to the beam of light. This test is used to help diagnose and manage certain types of cancers, such as leukemia and lymphoma.
  • FISH (fluorescence in situ hybridization): A laboratory test used to look at and count genes or chromosomes in cells and tissues. Pieces of DNA that contain fluorescent dyes are made in the laboratory and added to a sample of a patient’s cells or tissues. When these dyed pieces of DNA attach to certain genes or areas of chromosomes in the sample, they light up when viewed under a fluorescent microscope. The FISH test is used to help diagnose cancer and help plan treatment.
  • Gene mutation testing: A laboratory test in which cells or tissue are analyzed to look for changes in the TP53 or IgVH gene. These changes may be helpful to determine the patient's prognosis.
  • Serum immunoglobulin testing: A laboratory test that measures specific types of immunoglobulins (antibodies) in the blood. This may help diagnose cancer or find out how well treatment is working or if cancer has come back.
  • Hepatitis B virus and hepatitis C virus testing: A test to check for hepatitis B or hepatitis C virus in the blood. Infection with one of these viruses causes hepatitis (inflammation of the liver).
  • HIV testing: A test to check for human immunodeficiency virus (HIV) infection. HIV is the virus that causes acquired immunodeficiency syndrome (AIDS). The most common type of HIV test is called the HIV antibody test, which checks for antibodies against HIV in a sample of blood, urine, or fluid from the mouth.

Certain factors affect treatment options and prognosis (chance of recovery).

Treatment options depend on the following:

  • The red blood cell, white blood cell, and platelet blood counts.
  • Whether the liver, spleen, or lymph nodes are larger than normal.
  • Whether there are signs or symptoms, such as fever, chills, or weight loss.
  • The response to initial treatment.
  • Whether the CLL has recurred (come back).

The prognosis depends on the following:

  • Whether there are certain gene changes, such as the IgVH mutation.
  • Whether lymphocytes have spread throughout the bone marrow.
  • The red blood cell, white blood cell, and platelet blood counts.
  • Whether the liver, spleen, or lymph nodes are larger than normal.
  • The results of certain blood tests, such as the beta-2 microglobulin test.
  • The patient's age and general health.
  • Whether the CLL gets better with treatment or has recurred (come back).
  • Whether the CLL progresses to lymphoma or becomes prolymphocytic leukemia.

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