Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia is a type of blood cancer that originates from the bone marrow and circulates in the blood stream. The bone marrow is a spongy material that lives inside a person’s bones and is responsible for making all types of blood cells including white blood cells, red blood cells, and platelets. In chronic lymphocytic leukemia, the bone marrow functions normally, but the cancer cells also live there. Patients can develop low platelets and low red blood cells if there are enough leukemic cells living in the bone marrow.

It is also common to have enlarged lymph nodes or an enlarged spleen. The most common way patients present is that an elevated white blood cell count is found on routine blood work. Primary care physicians may notice a slowly elevating white blood cell count over years. Other symptoms include enlarged lymph nodes, feeling full quicker, fatigue, fevers, night sweats where a person drenches through their clothes, and weight loss. It is also common for patients to have frequent infections and symptoms where the immune system fights their healthy tissues. In chronic lymphocytic leukemia, this most commonly occurs by lowering the platelet count or the red blood cell count. There is also an association with skin cancer and chronic lymphocytic leukemia so patients should see a skin specialist yearly. Diagnosis is typically made through laboratory studies.

The medical hematologist/oncologist will order a test called flow cytometry which looks to see the proteins expressed on these abnormal cells to determine if this is indeed chronic lymphocytic leukemia. They will also look at your cells underneath the microscope. Your physician may also order a CT scan or a bone marrow biopsy. Typically, your physician will also order special studies that evaluate the genetics of your cancer cells as this will help with treatment decisions and progrnosis. In regards to treatment, many patients do not require treatment for their disease initially. Patients can actually live their whole life without requiring therapy. They can be treated with a “watchful waiting” approach where they need to follow-up with their medical hematologist/oncologist. Patients will only require therapy if they have evidence of bothersome lymph nodes, are having symptoms, their red blood cells are decreasing, or their platelets are decreasing. Currently, treatment can involve pills daily or chemotherapy through the vein. The type of medications used is based upon age and the genetics of your cancer cells. There is a risk of this type of lymphoma changing into an aggressive lymphoma at some point.

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