chronic lymphocytic leukemia

What is Chronic Lymphocytic Leukemia (CLL)?

Chronic lymphocytic leukemia (CLL) is a type of cancer that affects the blood and bone marrow. It is characterized by an abnormal proliferation of mature white blood cells, known as lymphocytes, in the bone marrow.

• CLL typically progresses more slowly than other types of leukemia [1].
• The cancer cells start in the bone marrow but then go into the blood [2].
• CLL is the most common form of leukemia in adults [3].

Causes and Risk Factors

The exact cause of CLL is unknown, but it is believed to be related to a combination of genetic and environmental factors. CLL mainly affects older adults and accounts for about one-third of all leukemias [12].

Symptoms and Diagnosis

CLL can have no symptoms in its early stages, but as the disease progresses, individuals may experience fatigue, weight loss, and frequent infections. A physical exam, medical history, blood tests (such as a complete blood count with differential), and blood chemistry tests are used to diagnose CLL [13].

Treatment Options

While there is no cure for CLL, healthcare providers can provide treatments to eliminate symptoms and signs of disease, putting the condition into remission [3]. Treatment options may include medications, chemotherapy, or targeted therapy.

Statistics and Demographics

CLL is extremely rare in children and most cases occur during or after middle age. The American Cancer Society estimates that there will be almost 19,000 new cases of CLL in the United States in 2023, with about 4500 deaths [5].

References:

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Common Signs and Symptoms of Chronic Lymphocytic Leukemia (CLL)

Chronic lymphocytic leukemia (CLL) is a type of cancer that affects the blood and bone marrow. It is characterized by an abnormal increase in the number of white blood cells, specifically lymphocytes, which can crowd out healthy red blood cells and other essential cells.

Common Symptoms:

• Fatigue: Feeling tired or weak due to anemia (decreased red blood cell count) [1][4]
• Swollen Lymph Nodes: Painless swelling of the lymph nodes in the neck, underarm, stomach, or other areas [6][8]
• Shortness of Breath: Difficulty breathing during normal physical activity due to anemia [2][5]
• Anemia: Decreased red blood cell count leading to pale skin and shortness of breath [4][7]
• Fever: Elevated body temperature indicating infection [4][7]
• Pain in the Upper Left Abdomen: Pain caused by an enlarged spleen [1]

Other Possible Symptoms:

• Weight loss
• Infections that won't get better
• Bleeding or bruising easily
• Feeling tired even after resting

It's essential to note that not everyone with CLL will experience all of these symptoms, and some people may have no symptoms at all. If you're experiencing any of these symptoms, it's crucial to consult a healthcare professional for proper diagnosis and treatment.

References: [1] - Symptoms · Enlarged, but painless, lymph nodes · Fatigue · Fever · Pain in the upper left portion of the abdomen, which may be caused by an enlarged ... [2] - Get Personalized Information & Support · Fatigue · Shortness of breath during normal physical activity · Anemia (decreased red blood cell count) · Lymph node ... [3] - Swollen lymph glands or tummy (abdominal) discomfort from an enlarged spleen · Weight loss · Infections that will not get better · Bleeding or bruising · Feeling ... [4] - CLL affects your red blood cells, causing anemia. Fatigue is a common anemia symptom. Fever. Fever is a sign of infection. CLL affects healthy white blood cells ... [5] - Apr 19, 2024 — Chronic lymphocytic leukemia symptoms may include fatigue, swollen lymph nodes, shortness of breath, anemia and fever. Learn the CLL signs ... [6] - Oct 15, 2024 — Signs and symptoms of CLL include swollen lymph nodes and feeling tired. · Painless swelling of the lymph nodes in the neck, underarm, stomach, ... [7] - Oct 14, 2024 — Symptoms of CLL · getting infections often · anaemia – persistent tiredness, shortness of breath and pale skin · bleeding and bruising more easily ... [8] - Main symptoms of chronic lymphocytic leukaemia · swollen glands, usually in your neck or under your arms · losing weight · getting ill a lot · feeling tired even ...

Diagnosing Chronic Lymphocytic Leukemia (CLL)

Chronic lymphocytic leukemia (CLL) can be diagnosed through various tests that examine the blood, bone marrow, and other tissues. Here are some of the key diagnostic tests used to diagnose CLL:

• Blood Tests: Blood tests, also known as complete blood counts (CBCs), are often the first step in diagnosing CLL [1]. These tests measure the number of red cells, white cells, and platelets in the blood. People with CLL typically have an increased number of lymphocytes (a type of white blood cell) [5].
• Immunophenotyping Tests: Immunophenotyping tests are used to identify specific proteins on the surface of lymphocytes. These tests can help confirm a diagnosis of CLL by identifying characteristic changes in the protein expression of lymphocytes [2].
• Bone Marrow Biopsy: A bone marrow biopsy is a procedure where a sample of bone marrow is taken from the hipbone or sternum. This test can confirm the presence of leukemia cells in the bone marrow, which is essential for diagnosing CLL [12].
• Flow Cytometry: Flow cytometry is a blood test that uses specialized equipment to analyze the characteristics of lymphocytes. This test can help diagnose CLL by identifying specific changes in the protein expression of lymphocytes [7].

Other Tests

While not always necessary, other tests may be used to confirm a diagnosis of CLL or rule out other conditions. These include:

• CT Scans: CT scans (CAT scans) may be ordered to evaluate the extent of disease spread and identify any potential complications [10].
• Biopsy: A bone marrow biopsy is sometimes performed to confirm the presence of leukemia cells in the bone marrow.

References

[1] Context 2: October 4, 2024 - Your doctor can usually diagnose CLL by doing a number of checks on your blood sample cells. These are called immunophenotyping tests. You then may have other tests to find out more information about your CLL. [2] Context 2: October 4, 2024 [3] Context 8: NYU Langone doctors diagnose chronic lymphocytic leukemia based on the results of sophisticated blood and tissue tests. Learn more. [4] Context 9: April 28, 2022 - A doctor may order several tests to diagnose CLL, such as blood tests, bone marrow tests, and biopsies. A doctor usually takes a blood sample from a person’s arm to look for factors that may indicate CLL. ... During a complete blood count and blood cell exam, also known as peripheral blood ... [5] Context 5: After your doctor or clinician takes your blood, he or she sends it to a lab for a complete blood count (CBC), which shows the number of red cells, white cells and platelets in your blood. · A person with CLL will have increased numbers of lymphocytes (a type of white blood cell). [6] Context 7: February 22, 2023 - Confirming a correct diagnosis of chronic lymphocytic leukemia is essential before deciding on a treatment plan. "The diagnosis is typically established by a blood test called flow cytometry," says Dr. [7] Context 7: February 22, 2023 [8] Context 10: Most patients newly diagnosed with CLL will not require imaging tests. If your physician recommends one, it will most likely be a CT scan (CAT scan). A CT scan ... [9] Context 12: Biopsy: A bone marrow biopsy is the only way to confirm that leukemia cells are present in the bone marrow. There are two ways your doctor can obtain bone marrow, and some people will have both procedures during the same visit. [10] Context 10: Most patients newly diagnosed with CLL will not require imaging tests. If your physician recommends one, it will most likely be a CT scan (CAT scan). A CT scan ... [11] Context 13: Find out about the main tests for diagnosing chronic lymphocytic leukaemia and what other tests you may need. [12] Context 12: Biopsy: A bone marrow biopsy is the only way to confirm that leukemia cells are present in the bone marrow. There are two ways your doctor can obtain bone marrow, and some people will have both procedures during the same visit.

Treatment Options for Chronic Lymphocytic Leukemia (CLL)

Chronic lymphocytic leukemia (CLL) is a type of cancer that affects the blood and bone marrow. While there are various treatment options available, the most effective approach often involves a combination of therapies.

Targeted Therapy

• BTK inhibitors: Ibrutinib (Imbruvica), zanubrutinib (Brukinsa), and acalabrutinib (Calquence) have been shown to be effective in treating CLL. These medications target the Bruton tyrosine kinase enzyme, which is involved in the growth and survival of cancer cells [1][2].
• BCL2 inhibitors: Venetoclax (Venclexta) is a BCL2 inhibitor that may be used alone or in combination with rituximab or obinutuzumab to treat CLL. It works by targeting the BCL2 protein, which helps cancer cells survive [5].

Chemotherapy

• Traditional chemotherapy: Fludarabine, cyclophosphamide, and dexamethasone are some of the chemotherapy drugs traditionally used to treat CLL. However, newer treatments have been developed to improve outcomes [6][7].
• Combination chemotherapy: The combination of fludarabine, cyclophosphamide, and rituximab (FCR) is often the initial choice for treatment. Other combination regimens may also be used [8].

Other Treatment Options

• Acalabrutinib maleate monohydrate, alemtuzumab, arzerra (ofatumumab), bendamustine, and obinutuzumab are some of the other drugs approved for CLL treatment [9].
• Combination therapy: A combination of acalabrutinib, zanubrutinib, or venetoclax with obinutuzumab may be prescribed as a first-line treatment for CLL [10].

It's essential to note that each patient's situation is unique, and the most effective treatment plan will depend on individual factors such as age, overall health, and disease characteristics. Consultation with a healthcare professional is necessary to determine the best course of action.

References:

[1] Jul 1, 2024 — Initial treatment of CLL · A BTK inhibitor such as ibrutinib (Imbruvica), zanubrutinib (Brukinsa), or acalabrutinib (Calquence), either alone or ...

[2] Jul 1, 2024 — Ibrutinib (Imbruvica). Ibrutinib can be used in the initial treatment of CLL. It has also been shown to help when CLL is hard to treat, for ...

[3] Oct 15, 2024 — Targeted therapy with any of the following drugs: A tyrosine kinase inhibitor (acalabrutinib, zanubrutinib, or ibrutinib). Venetoclax with ...

[4] The main treatments · Bruton Tyrosine Kinase Inhibitors (BTKi), such as ibrutinib and acalabrutinib · B-cell lymphoma inhibitors (Bcl2) such as venetoclax.

[5] Venetoclax (Venclexta) is a BCL2 inhibitor that may be used alone or in combination with rituximab or obinutuzumab to treat CLL. It can be given as a first-line ...

[6] Some of the chemotherapy drugs traditionally used to treat chronic lymphocytic leukemia include fludarabine, cyclophosphamide, and dexamethasone. Newer ...

[7] Aug 23, 2024 — Chemotherapy. Chemotherapy is a drug treatment that kills quickly growing cells, including cancer cells. Chemotherapy treatments can be ...

[8] by A Aggarwal · 2015 · Cited by 1 — The combination chemotherapy fludarabine, cyclophosphamide, and rituximab (FCR) is often the initial choice for treatment. Other chemotherapy drugs used are ...

[9] Oct 4, 2024 — Drugs Approved for Chronic Lymphocytic Leukemia (CLL)

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Differential Diagnosis of Chronic Lymphocytic Leukemia (CLL)

Chronic lymphocytic leukemia (CLL) is a type of cancer that affects the blood and bone marrow. The differential diagnosis of CLL involves identifying other conditions that may present with similar symptoms or laboratory findings.

Conditions to Consider

• Acute Lymphoblastic Leukemia (ALL): A more aggressive form of leukemia that requires immediate treatment.
• Acute Promyelocytic Leukemia: A rare and aggressive form of leukemia characterized by the accumulation of immature white blood cells.
• Diffuse Large Cell Lymphoma: A type of non-Hodgkin lymphoma that can present with similar symptoms to CLL.
• Follicular Lymphoma: Another type of non-Hodgkin lymphoma that may be considered in the differential diagnosis of CLL.
• Hairy Cell Leukemia: A rare and slow-growing form of leukemia characterized by the presence of abnormal white blood cells.

Key Diagnostic Features

To distinguish CLL from these conditions, several key diagnostic features are important to consider:

• Lymphadenopathy: The presence of swollen lymph nodes is a characteristic feature of CLL.
• Absence of cytopenias: CLL typically does not cause a decrease in the number of red blood cells, white blood cells, or platelets.
• Immunohistological examination: This test can help distinguish CLL from other conditions by identifying specific markers on the surface of white blood cells.

Diagnostic Tests

Several diagnostic tests may be used to diagnose CLL and rule out other conditions:

• Complete Blood Count (CBC): A blood test that measures the number of red blood cells, white blood cells, and platelets.
• Flow Cytometry: A test that examines the characteristics of white blood cells.

References

1. The diagnosis of SLL requires the presence of lymphadenopathy and absence of cytopenias that are attributable to bone marrow infiltration of the [1].
2. Differential Diagnosis · Acute Lymphoblastic Leukemia (ALL) · Acute promyelocytic leukemia · Diffuse large cell lymphoma · Follicular lymphoma · Hairy cell leukemia [2].
3. Immunohistological examination can easily distinguish these two lymphomas. The most important characteristic of CLL/SLL is CD5 and CD23 positivity [3].
4. The differential diagnosis of CLL arises with both primary B-cell leukaemias and B-cell lymphomas presenting with leukaemia, and T-cell derived conditions, such as monoclonal B-cell lymphocytosis (MBL) [4][9].

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