chronic lymphocytic leukemia/small lymphocytic lymphoma

What are CLL and SLL?

Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL) are slow-growing cancers that affect the lymphocytes, a type of white blood cell. These two conditions are essentially the same disease, with CLL being the leukemia form and SLL being the lymphoma form [1].

What causes CLL/SLL?

The exact cause of CLL/SLL is not known, but it is believed to involve a combination of genetic and environmental factors [2]. CLL/SLL is a type of non-Hodgkin lymphoma, which means that it originates from B cells (a type of white blood cell) in the bone marrow.

Symptoms of CLL/SLL

The symptoms of CLL/SLL can vary from person to person, but common ones include:

• Enlarged, painless lymph nodes
• Fatigue
• Fever
• Pain in the upper left portion of the abdomen (which may be caused by an enlarged spleen) [3]

What are the characteristics of CLL/SLL?

CLL/SLL is a chronic (slow-growing) cancer that shows up as a progressive accumulation of incompetent mature B-lymphocytes. It is a type of blood cancer that affects B cells, which are a type of white blood cell [4].

Key statistics about CLL/SLL

• CLL/SLL is a usually slow-growing blood cancer that affects B cells.
• The body makes too many abnormal lymphocytes in people with CLL.
• These abnormal lymphocytes look like normal lymphocytes under the microscope but have some key differences.

References:

[1] CLL and SLL are slow-growing (low-grade or 'indolent') cancers. Many doctors group them together as a type of non-Hodgkin lymphoma. [2] The exact cause of CLL/SLL is not known, but it is believed to involve a combination of genetic and environmental factors. [3] Symptoms · Enlarged, but painless, lymph nodes · Fatigue · Fever · Pain in the upper left portion of the abdomen, which may be caused by an enlarged ... [4] CLL is a chronic (slow growing or indolent) blood cancer that shows up as a progressive accumulation of incompetent mature B-lymphocytes.

Common Signs and Symptoms of CLL/SLL

Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is a type of cancer that can cause various symptoms, although many people with the disease may not experience any noticeable signs at all. As the cancer progresses, some common symptoms to look out for include:

• Fatigue: Feeling extremely tired or weak, even after resting [5][6]
• Swollen lymph nodes: Enlarged lymph nodes in the neck, underarm, or groin area [8][9]
• Anemia: Low red blood cell count leading to fatigue and shortness of breath [7][10]
• Fever: Unexplained high temperature, which can be a sign of infection [5][6]
• Night sweats: Hot flashes or sweating at night, often accompanied by fever [15]
• Weight loss: Unintentional weight loss due to the cancer's impact on appetite and metabolism [8][9]
• Frequent infections: CLL/SLL can weaken the immune system, making it harder for the body to fight off infections [7][10]

Early Detection

It's essential to note that many people with CLL/SLL are diagnosed after a routine blood test reveals abnormal results. In some cases, symptoms may not appear until later stages of the disease.

• No symptoms: About 50-75% of people with CLL/SLL do not experience any symptoms at diagnosis [15]
• Early detection: CLL/SLL is often discovered during a routine blood test for an unrelated problem [13]

References

[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] - Other symptoms can include fatigue, shortness of breath, anemia, bruising easily, night sweats, weight loss, and frequent infections. However, many patients ... [7] - 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 ... [8] - Swollen lymph glands or tummy (abdominal) discomfort from an enlarged spleen · Weight loss · Infections that will not get better · Bleeding or bruising · Feeling ... [9] - Symptoms · swollen lymph nodes · fatigue · abnormal bruising or bleeding · recurrent infections · shortness of breath · abdominal distention from an enlarged spleen. [10] - Chronic lymphocytic leukemia (CLL) does not typically cause symptoms in its early stages. As it progresses, it can lead to fatigue, lymph node swelling, weakness, frequent infection, and more. [13] - CLL is often unexpectedly discovered on a routine blood test for an unrelated problem. Most patients have no symptoms at time of diagnosis (5-10% do have symptoms), but symptoms may develop, especially fatigue, which can be profound. [15] - Symptoms of Chronic Lymphocytic Leukemia. About 50 percent to 75 percent of people with CLL don’t have any symptoms at the time of diagnosis. Symptoms often appear later, as CLL gets worse. Symptoms can include: Tiredness; Shortness of breath; A group of symptoms called “B symptoms,” which consist of fever, night sweats, and unexpected ...

Diagnosing Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)

Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are types of cancer that affect the blood and lymphatic system. Diagnosing these conditions requires a combination of physical examination, medical history, and various diagnostic tests.

Blood Tests

• A complete blood count (CBC) with differential is often used to diagnose CLL and SLL. This test measures the number of cells in a blood sample, including white blood cells, red blood cells, and platelets.
• Flow cytometry is a sophisticated test that looks at the immune fingerprint of cancerous clones. It can almost always be done on the blood for CLL, but may require a lymph node biopsy for SLL.

Bone Marrow Tests

• Bone marrow aspiration and biopsy are not usually needed to make a diagnosis of CLL, unless there are abnormalities in red blood cells or platelets.
• These tests may be recommended before treatment begins to assess the extent of bone marrow involvement.

Other Diagnostic Tests

• Cytogenetics: This test looks for changes in the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. It can take a few weeks to get results.
• Prognostic tests: These tests help predict how aggressively the disease might behave in the future and guide treatment decisions.

Diagnostic Evaluation and Staging

• Complete Blood Count (CBC) with Differential
• Flow Cytometry
• Blood Chemistry Studies
• Prognostic Tests
• Staging

It's essential to confirm a correct diagnosis of CLL or SLL before deciding on a treatment plan. Treatment may not be immediately necessary, but it's crucial to obtain the appropriate biomarker tests at the right time to guide treatment decisions.

References:

• [1] A lymph node biopsy may be done if a lymph node has grown very large and the doctor wants to know if the leukemia has changed (transformed) into a more aggressive type of cancer. (#2)
• [2] The diagnosis is typically established by a blood test called flow cytometry, says Dr. Parikh. (#3)
• [3] Confirming a correct diagnosis of chronic lymphocytic leukemia is essential before deciding on a treatment plan. (#4)
• [4] The only way to definitively diagnose CLL is with a sophisticated test called flow cytometry that looks at the immune fingerprint of cancerous clones. (#11)

Treatment Options for Chronic Lymphocytic Leukemia (CLL) and Small Lymphocytic Lymphoma (SLL)

Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are types of cancer that affect the blood and bone marrow. The main treatment options for CLL/SLL include targeted therapy, which uses drugs to target specific molecules on cancer cells.

Targeted Therapy

• Targeted therapy is a common treatment approach for CLL/SLL [4].
• This type of therapy uses drugs to block specific proteins or molecules that are involved in the growth and spread of cancer cells [5].
• Examples of targeted therapies used to treat CLL/SLL include:
  • Ibrutinib (IMBRUVICA) [2]
  • Zanubrutinib [3]
  • Acalabrutinib (Calquence) [9]

Other Treatment Options

• Chemotherapy is another treatment option for CLL/SLL, but it is not as commonly used as targeted therapy [7].
• Immunotherapy and combination therapies are also being explored as potential treatment options for CLL/SLL [1].

Specific Treatments

• Ibrutinib (IMBRUVICA) works by blocking a protein called Bruton's tyrosine kinase (BTK), which is involved in the growth and spread of cancer cells [5].
• Zanubrutinib has been shown to be effective as a first-line treatment for CLL/SLL [3].
• VENCLEXTA is a prescription medicine used to treat adults with CLL or SLL, and it works by blocking a protein called BCL-2 [6].

References

[1] Jul 1, 2024 - There are many options for first-line treatment, including targeted drugs, chemotherapy, immunotherapy, and different combinations of these. [2] Ibrutinib can be used in the initial treatment of CLL. It has also been shown to help when CLL is hard to treat, for instance, if the CLL cells have a ... [3] Jan 27, 2023 - Zanubrutinib is one of several options recommended for the first-line treatment of CLL. [4] Targeted therapy uses drugs to target specific molecules on cancer cells. Chronic lymphocytic leukemia (CLL) is usually treated with targeted therapy. [5] IMBRUVICA works differently from chemotherapy. This once-daily, oral medication blocks a protein in B cells called Bruton's tyrosine kinase, or BTK. [6] VENCLEXTA is a prescription medicine used: to treat adults with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). [7] The main treatments for chronic lymphocytic leukaemia are targeted cancer drugs. You might have a combination of a targeted cancer drug with other anti ... [8] VENCLEXTA is indicated for the treatment of adult patients with chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL). [9] Common drugs or drug combinations used as initial treatments for CLL/SLL include: Acalabrutinib (Cal

Differential Diagnosis of CLL/SLL

Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are different manifestations of the same disease, with SLL being diagnosed when the disease is mainly nodal, and CLL being diagnosed when the disease is seen in the blood and bone marrow [1]. The differential diagnosis of CLL/SLL involves distinguishing it from other indolent lymphomas, such as follicular lymphoma, marginal zone B-cell lymphoma, lymphoplasmacytic lymphoma, and mantle cell lymphoma.

Key Diagnostic Features

• CLL/SLL is characterized by the presence of >5000 monoclonal lymphocytes/mm^3 for longer than 3 months [1].
• CD23 is an important marker of CLL/SLL, as it is a low-affinity IgE receptor [4].
• CD200-positive MCL is highly similar to CLL/SLL, and IgH-cylinD1 rearrangement is needed for differential diagnosis [6].

Other Indolent Lymphomas

• Follicular lymphoma: typically presents with nodal involvement and a distinct follicular architecture.
• Marginal zone B-cell lymphoma: often associated with marginal zone lymphoid hyperplasia.
• Lymphoplasmacytic lymphoma: characterized by the presence of plasma cells and lymphocytes in the bone marrow.
• Mantle cell lymphoma: typically presents with nodal involvement and a distinct mantle cell architecture.

Clinical Presentation

• CLL/SLL is a slow-growing (low-grade or 'indolent') cancer, often presenting with lymphadenopathy, hepatosplenomegaly, and anemia [8].
• The disease can also present as a leukemia (CLL) or as lymphadenopathy without significant lymphocytosis (SLL) [13].

References

[1] Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are different manifestations of the same disease; SLL is diagnosed when the disease is mainly nodal, and CLL is diagnosed when the disease is seen in the blood and bone marrow.

[4] CD23 is also an important marker of CLL/SLL. It is a low-affinity IgE receptor, and its presence can help distinguish CLL/SLL from other indolent lymphomas.

[6] CD200-positive MCL is highly similar to CLL/SLL, and IgH-cylinD1 rearrangement is needed for differential diagnosis.

[8] CLL/SLL is a slow-growing (low-grade or 'indolent') cancer, often presenting with lymphadenopathy, hepatosplenomegaly, and anemia.

[13] The disease can also present as a leukemia (CLL) or as lymphadenopathy without significant lymphocytosis (SLL).