Chronic lymphocytic leukaemia
What is Chronic Lymphocytic leukaemia (CLL)?
Chronic lymphocytic leukaemia (CLL) is a type of slow growing leukaemia that affects developing B-lymphocytes. B lymphocytes (also known as B-cells) are specialised white blood cells. Under normal conditions they produce immunoglobulins (also called antibodies) that help protect our bodies against infection and disease. In people with CLL, lymphocytes undergo a malignant (cancerous) change and become leukaemic cells.
It is important to emphasise here that for many people CLL remains stable for many months and years and has little if any impact on their lifestyle or general health. Around 30 percent of people diagnosed with CLL never require any treatment for their disease and can survive for many years despite their diagnosis. For others, the leukaemic cells multiply in an uncontrolled way. Live longer than they are supposed to and accumulate in the bone marrow, blood stream, lymph nodes (glands), spleen, liver and other parts of the body. These cells are abnormal and as such they are unable to function properly. Over time, an excess number of lymphocytes crowd the bone marrow, and interfere with normal blood cell production. The bone marrow produces inadequate numbers of red cells, normal white blood cells and platelets, making some people with CLL more susceptible to anaemia, recurrent infections and bruising and bleeding easily. Circulating red blood cells and platelets can also be damaged by abnormal proteins made by the leukaemic cells.
CLL usually develops slowly and progresses slowly, over months and years. Most people have no symptoms of their disease when they are first diagnosed. In these cases, people often require no treatment for a long time, apart from regular checkups with their doctor to carefully monitor their health. Others may need to be treated soon after they are diagnosed.
How common is it?
Each year in Australia around 718 people are diagnosed with CLL*, making it the most common type of leukaemia. It is a rare disease overall however, accounting for around 0.8 per cent of all cancers diagnosed.
Who gets it?
The risk of developing CLL increases with age. Almost 80 per cent of all new cases are diagnosed in people over the age of 60 years. CLL is rare in people under 40. It occurs more frequently in men than in women.
What causes CLL?
The causes of CLL remain unknown but it is thought to result from damage to one or more of the genes that normally controls blood cell development . A family history may put some people at higher risk of developing CLL.
What are the symptoms?
Because CLL develops slowly many people don't have any symptoms, particularly in the early stages and the disease is picked up during a routine blood test.
For others, possible symptoms may include:
- swollen lymph nodes (glands) in the neck, under the arms or in the groin, due to collections of lymphocytes in these areas
- pain or discomfort under the ribs on the left side, due to an enlarged spleen
- anaemia, due to a lack of red cells ; causing persistent tiredness, dizziness, paleness, or shortness of breath when physically active.
- frequent or repeated infections and slow healing, due to a lack of normal white blood cells
- increased or unexplained bleeding or bruising, due to a very low platelet count
- excessive sweating at night
- unintentional weight loss
How is it diagnosed?
CLL is diagnosed by a full blood count (FBC) and a bone marrow biopsy/examination.
How is it treated?
CLL is generally a slow-growing disease and many people, particularly in the early stages, do not need treatment. Instead the doctor may recommend regular check-ups to carefully monitor their health. Treatment usually only starts once the disease begins to progress, or cause troublesome symptoms. Many people with CLL have the disease for years without it causing any problems.
Treatment can involve chemotherapy, which may be given either in tablet form or intravenously, through a vein in your hand or arm. Steroids may also be given. Drugs called monoclonal antibodies , for example rituximab (Mabthera®), may be given along with chemotherapy. This drug works by deliberately targeting abnormal lymphocytes, allowing chemotherapy to be delivered directly to these cells without causing harmful side effects to other parts of the body.
Occassionally, a stem cell transplant may be offered to some younger patients.
A range of supportive therapies are available to treat symptoms of CLL. These include antibiotics to prevent and treat infections, and blood & platelet transfusions to restore levels of red cells and platelets.
Your doctor and nurse will discuss with you the possible side-effects of any treatments you need and how they can be managed.
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