Chronic Lymphocytic Leukaemia (CLL)
Chronic Lymphocytic Leukaemia (or CLL) is a blood cancer which causes the bone marrow and other organs in the lymphatic system to produce excessive numbers of lymphocytes (a type of white blood cell).
Under normal conditions, the lymphocytes are charged with fighting infections and producing antibodies to attack any foreign agents that invade or manifest in the body.
CLL causes the excess infiltration of the lymphocytes in the bone marrow, the lymphatic tissues (glands and spleen fundamentally) and other organs (liver). The manifestation of the disease causes the displacement of normal blood cells and the irregular functioning of the affected organs. Additionally, the lymphocytes which are produced do not function properly and do not perform their mission to defend the organism.
Usually, CLL affects people over 60 years of age and progresses slowly. Each year the number of new cases is around 30 per million inhabitants.
Meet Francesc, ex-Chronic Lymphocytic Leukaemia patient.
Main Symptoms
In 70 of cases the diseases does not present any symptoms and the diagnosis is made coincidentally after a routine checkup.
Other can patients can be affected by the following manifestations: tiredness, persistent weakness, loss of weight, sweating at night, fever, inflamed lymphatic glands, and unspecific abdominal pains which are a consequence of the swelling of the spleen or liver. Some CLL patients have a tendency to suffer from repeated infections.
Study
The diagnosis of CLL can be established after a careful analysis of the blood, the bone marrow or one of the affected glands. In order to carry out the analysis, it will be necessary to take samples of the blood and the bone marrow (obtained through a puncture of the sternum or the hip bone), a bone marrow biopsy (obtained through the extraction of a cylinder of bone from the hip), and a biopsy one of the swollen glands (carried out under local anesthetic). In addition, the affected glands should be analysed further through x-rays, ultrasound, scintigraph, or MRI scan.
Treatment
CLL patients might not require treatment for years during the initial phases of the disease and could maintain a relatively normal unaffected life. It is possible that the only requirement will be to monitor the disease to assess whether it is progressing or remaining stable.
Other patients should receive chemotherapy or even radiotherapy on occasions (to treat the inflammation of the spleen or glands). Surgery might be required to remove the spleen. Depending on the age of the patient, the severity of the disease and the speed of its progression, the degree of intensity and the method (orally or intravenously) of chemotherapy will vary.
Some of these intense chemotherapies are so effective that, occasionally, a complete molecular remission of the disease is achieved. However, it is not possible to detect this situation even with the most advanced technology. Although, a remission of the disease can be maintained for a number of years a complete cure can never be achieved.
Today, the use of biotherapy agents is common. Using monoclonal antibodies, these agents specifically attack the leukaemia cells without damage the healthy cells. Through this method it is possible to improve the chemotherapy results of a patient or boost the chances of a patient who was not responding to treatment.
A difference between Chronic Lymphocytic Leukaemia and other types of leukaemia is that a bone marrow transplant is not normally a treatment option due to the advanced age of most patients. However, younger patients with aggressive CLL could benefit from this form of treatment if a compatible donor can be found, because it may be their only hope for a cure. Recently, older patients have been treated with a new hematopoietic transplant of reduced intensity. The results of these new treatments have been favourable. In the case that a donor does not exist when a molecular remission has been reached, an autologous transplant can be carried out, which will not cure the disease completely but can significantly extend the duration of the remission.
For more information, you can consult the following webpages:
• National Cancer Institute
• Fundación Leucemia y Linfoma
• Médica Medline Plus Encyclopedia
• The Leukaemia & Lymphoma Society
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