If you or a family member was recently diagnosed with lymphocytic leukemia, you more than likely have a lot of questions, starting with what is the difference between chronic and acute lymphocytic leukemia? And what is the prognosis for patients with this disease? We will explore the answers to these questions and more to help you further understand this type of leukemia.
What is Chronic Lymphocytic Leukemia?
Chronic lymphocytic leukemia (CLL) is a type of cancer that begins when white blood cells grow uncontrollably in the bone marrow. Specifically, the cells that start to grow out of control are the lymphocytes in the white blood cells.
It’s the most common type of leukemia in adults and tends to be slow-growing. For some patients, symptoms don’t develop for years! Eventually, the cells move from the bone marrow into the bloodstream and it can then start to affect other organs such as the lymph nodes, liver, and spleen.
The Difference between Chronic and Acute Lymphocytic Leukemia
With chronic lymphocytic leukemia, the cancer cells are slower to produce which means symptoms are barely noticeable over time. For these patients, it's often a blood test that identifies the problem.
Acute lymphocytic leukemia is much faster-growing, causing symptoms sooner. Treatment for these patients typically needs to begin right away.
Who's at Risk for Developing Chronic Lymphocytic Leukemia?
Currently, we have only a few identified risk factors for CLL including:
- Being over fifty years of age. Most patients are diagnosed in their 60s and 70s.
- Being overly exposed to the herbicide Agent Orange, Round Up, or other glyphosate herbicides.
- Exposed to radon gas over a long period of time.
- Have immediate relatives diagnosed with chronic lymphocytic leukemia.
- Being female.
Common Symptoms of CLL
Since chronic lymphocytic leukemia usually grows rather slowly, you may not show any signs or symptoms for a while. Talk to your doctor if you start to notice:
- Swelling in the lymph nodes (located in the neck, armpit, stomach, or groin) that isn’t related to a recent virus infection or vaccine
- Fatigue that doesn’t get better after getting good rest
- A feeling of fullness in your stomach
- Fever for no known reason
- Being bruised easily or bleeding often
- Dark red spots under the skin referred to as petechiae
- Weight loss without explanation
- Night sweats not related to menopause
It’s important to have your annual physical exam with blood work so that your primary care doctor can look at your white blood cell count. If they notice anything unusual they can do further testing even if you don’t have symptoms.
Tests to Find Out if It’s Leukemia
If your primary care doctor feels that your white blood cell count is too high and can’t be explained by a recent infection, they may refer you to a hematologist. Hematologists are also oncologists or cancer specialists.
The hematologist is likely to request more blood tests and a bone marrow test. This is one of the best ways to see what’s happening in the bone marrow cells. The samples are biopsied to identify if cancer is present and if so, what type. The samples are typically taken around the hip bone, but that is not the only location on the body that’s used.
A flow cytometry blood test helps determine the exact kind of leukemia. This blood test also shows if tumor cells have a normal or abnormal amount of DNA. The results reveal the rate the tumor is growing and if it is likely to grow quickly or slowly.
If a CLL diagnosis is confirmed, your hematologist will talk with you about whether treatment is needed now, and what types of treatments are recommended if you need to start therapy.
Lymphocytic Leukemia Treatment Options
Below are the types of lymphocytic leukemia treatments your hematologist may recommend.
If you don’t have symptoms and the CLL is growing slowly, you’ll be scheduled for regular checkups with the hematologist who will look for signs that the cancer cells are starting to grow faster or are moving into the blood.
Because leukemia is in the blood, you will need a treatment that can have an impact on all areas of the body, like chemotherapy. These drugs destroy cancerous cells throughout the entire body.
Immunotherapy: Monoclonal Antibodies
These are man-made antibodies that are created to attach to the cancerous cells. This activates your body’s immune response to defeat the harmful cells. Often this is done in conjunction with chemotherapy.
Targeted Therapy: Kinase Inhibitors
These drugs block kinases, which are proteins in cells that normally relay signals (such as telling the cell to grow). Many different types of kinases exist, and there are two that are targeted by specific drugs used to treat CLL: Bruton's tyrosine kinase (BTK) and PI3K.
Stem Cell Transplant
This is not used for every patient, but if other treatments aren’t working a stem cell transplant can allow the patient to receive stem cells that help normalize and repair the damaged bone marrow. Typically, the bone marrow cells come from the patient (autologous) or from the bone marrow of another person (allogeneic). The patient’s bone marrow is treated with high-dose chemo and/or radiation before the healthy bone marrow cells are placed into the patient so they can grow.
Radiation therapy is not often used for CLL treatment. In certain situations it can be used to treat symptoms of CLL. Radiation therapy can also be given in low doses to prepare for a stem cell transplant.
What’s Right for You?
When the time comes for treatments to start, your hematologist will talk with you about the recommended plan and the side effects you may face. They may also discuss possible clinical research trials that you may be eligible to participate in.
Some patients find that they can work throughout their treatments, while others may feel exhausted and unable to do so. You will know what’s best for you as you go through the cancer treatment process. Listen to your body and give yourself some grace from the regular rigors of life.
Can You Survive CLL?
Because chronic lymphocytic leukemia is slow-growing, many people live with it for a long time. CLL has a higher survival rate than many other cancers with 83% of patients surviving at least five years after diagnosis and many patients making it to 10 years after diagnosis. Patients who are diagnosed earlier so that treatment can begin before the cancer has progressed too far will have the best outcomes.
If you’d like to discuss the best course of action for a CLL diagnosis, please request an appointment with one of our hematologists/medical oncologists located throughout Colorado. We want to ensure you have the right resources and information to make an educated decision on when and how to proceed with cancer treatment.