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What is chronic Lymphocytic Leukaemia (CLL)?

Chronic Lymphocytic Leukaemia is a type of blood cancer of the white blood cells. It develops from a type of white blood cell central to the immune system called Lymphocyte.

The term “Chronic” implies that the condition typically progresses more slowly than other forms of Leukaemia.

Lymphocytes, made in the soft center of our bones, called the Bone Marrow, help our body fight infections. In a person with the condition, the body makes an abnormally high number of Lymphocytes that don’t work properly. Over time, this causes a range of problems, such as an increased risk of picking up infections, persistent tiredness, swollen glands in the neck, armpits or groin, and unusual bleeding or bruising.

CLL most commonly affects older adults – over the age of 60 and is rare in people under 40. Children are almost never affected.

What are the Symptoms of Chronic Lymphocytic Leukaemia (CLL)?

Most people with Chronic Lymphocytic Leukaemia have no early symptoms and may only be picked up by a doctor during a blood test carried out for another reason. And those who develop signs and symptoms may experience:

  • Swollen/ enlarged, but painless, Lymph Nodes in the neck, armpits, stomach, or groin
  • Anaemia – persistent tiredness, shortness of breath and pale skin
  • Pain in the upper left portion of the abdomen, which may be caused by an enlarged spleen
  • Night sweats
  • Fever and infections
  • Loss of appetite and weight

Since the symptoms don’t appear early and could be because of other causes as well, it is always best to speak to your doctor or a Haematologist (specialist blood doctor) if any of these symptoms persist over some time.

What causes Chronic Lymphocytic Leukaemia (CLL)?

Doctors, or Haematologists (specialist blood doctors) aren’t certain what causes CLL. However, what’s known is that something triggers to cause a genetic mutation in the DNA of blood-producing cells that causes the blood cells to produce abnormal, ineffective lymphocytes. These abnormal and ineffective Lymphocytes accumulate in the blood and certain organs causing complications and crowding out healthy cells out of the bone marrow.

There are certain factors that may increase the risk of CLL. They include:

  • Age – CLL occurs most often in older adults – on an average, people diagnosed with CLL are in their 70s.
  • Family History of Blood & Bone Marrow Cancers – this may increase the risk of acquiring CLL
  • Exposure to Chemicals – certain herbicides and insecticides

OVERALL, AROUND THREE IN EVERY FOUR PEOPLE WITH CLL WILL LIVE AT LEAST FIVE YEARS AFTER DIAGNOSIS, BUT THIS CAN RANGE FROM 10 YEARS OR MORE IF CAUGHT EARLY ON, TO LESS THAN A YEAR IF CAUGHT AT A VERY ADVANCED STAGE.

How is Chronic Lymphocytic Leukaemia (CLL) Diagnosed?

In most cases, CLL is detected during blood tests carried out for some other reason. It is advised to visit a doctor if the symptoms persist over time.

If the doctor thinks that someone has CLL, he/ she would ask the person to refer to a doctor who is a specialist in blood disorders, called a Haematologist for further tests. These tests include:

A Blood Test called a Full Blood Count:

This is where the number and appearance of the different blood cells in a sample of the blood are checked in a lab. An abnormally high number of unusual white blood cells (Lymphocytes) can be a sign of CLL. A further detailed examination of these cells can confirm the diagnosis.

X-Rays and Scans:

Chest X-Ray, Ultrasound Scan of the tummy or a CT (Computerised Tomography) Scan to check for problems caused by CLL, such as swollen glands or a swollen spleen. These can help rule out other possible causes of the symptoms.

Bone Marrow Exam:

A Bone Marrow Exam is the ONLY definite way for a Haematologist to detect or determine uncommon conditions such as various types of blood cancers. The exam comprises two different procedures – a Bone Marrow Aspiration and a Bone Marrow Biopsy. (For more information, read Bone Marrow Aspiration and Biopsy)

Flow cytometry:

This is a specialised test performed on the peripheral blood sample or the sample collected from the bone marrow which confirms the diagnosis of CLL and distinguishes it from other similar looking disorders of lymphocytes. It also helps in determining the prognosis along with the genetic tests.

Lymph Node Biopsy:

In some cases, removing and examining a swollen lymph gland can help confirm a diagnosis of CLL.

Genetic Tests:

The Haematologist might also check for unusual genes in the cancerous cells – identifying these unusual genes can help the Haematologist decide how soon the treatment should start and which treatment would work best.

What are the stages of Chronic Lymphocytic Leukaemia (CLL)?

The stages describe how far CLL has developed and this helps Haematologists determine the treatment protocol.

There are three main stages of CLL:

  • Stage A
    • Enlarged Lymph Glands in fewer than three areas (such as neck, armpit or groin)
    • High White Blood Cell count
  • Stage B
    • Enlarged Lymph Glands in three or more areas
    • High White Blood Cell count
  • Stage C
    • Enlarged Lymph Glands or an Enlarged Spleen
    • High White Blood Cell count
    • Low Red Blood Cell or Platelet count

Stage B and Stage C CLL are immediately treated and Stage A is generally treated if the condition gets worse quickly or starts to cause symptoms.

How is Chronic Lymphocytic Leukaemia (CLL) Treated?

Treatment for CLL largely depends on what stage the condition is at when it’s diagnosed. People with early-stage CLL typically don’t receive treatment – studies have shown that early treatment doesn’t help, as with some other cancers. However, it is advised that the patient with persistent symptoms should keep up with visits to the doctor to closely monitor the condition.

The treatment for CLL may include:

  • Chemotherapy – drugs, oral or intravenous – Haematologists often combine two or more drugs that work in different ways to kill the cancer cells.
  • Immunotherapy – Often given along with Chemotherapy, these drugs prompt the body’s immune system to recognise and destroy cancer cells.
  • Radiation Therapy – Use of high-energy rays, such as X-rays, to destroy cancer cells. This therapy is used to shrink swelling in the lymph nodes, in the spleen or in another organ that’s causing pain. This is used rarely nowadays
  • Targeted Therapy – These medicines block the proteins that cancer cells use to survive and spread.
  • Surgery – Though rare, surgery works when chemotherapy or radiation therapy doesn’t reduce an enlarged spleen
  • Bone Marrow or Stem Cell Transplant – For more information, read Stem Cell Transplant

Since early stage of cll is usually not treated, how can you monitor early stage or stage a CLL?

Since CLL often develops very slowly and doesn’t cause symptoms for many years, treatment may not be needed as it doesn’t benefit the patient and treatment can cause significant side effects.

In these cases, the patient should normally make regular visits to a Haematologist and undergo blood tests to monitor the condition.

What are the Side Effects of Treatment?

The medicines used to treat CLL can cause significant side effects, however, most side effects pass once the treatment stops. The side effects could include:

  • Persistent tiredness
  • Feeling of being sick
  • Increased risk of infections
  • Easy bruising or bleeding
  • Anaemia – shortness of breath, weakness and pale skin
  • Hair loss or thinning
  • Irregular heartbeat
  • Allergic reactions
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