Chronic Lymphocytic Leukemia

  • What is chronic lymphocytic leukemia?

There is lot of difference between ACUTE and CHRONIC. Chronic leuekmias are very indolent, do not need hospitalization and people can live even with the disease for many years.

Before getting to know about  leukemia, one should know about the basics of blood cells in our body.

Our blood has three types cells in it.

  1. The red cells are predominant and they help in carrying oxygen from the lungs to all the tissues of the body.
  2. The white cells fight against various bacteria and viruses entering our body and help to protect against infections.
  3. The platelets are the cells which constantly help in repairing any tears occurring in our blood vessels and so help to prevent any bleeding

The blood cells after circulating in the body are  destroyed in our blood after some days. So they have to be replaced continuously . All these cells are constantly produced in the bone marrow.  Bone marrow is a tiny space present inside most of our bones.

The blood cells have to be constantly produced in the marrow to keep the blood, function properly. If for some reasons, the bone marrow does not produce enough cells or produce bad quality cells, then various problems arise.

Leukemia is one condition in which the white blood cells in the bone marrow are produced in excess of what is needed. Not only they are produced in excess, but they cannot mature properly . These immature cells accumulate in the bone marrow and affect the production of other cells such as red cells and platelets.

Leukemia is abnormal proliferation of white cells.

Chronic lymphocytic leukemia refers to abnormal proliferation of mature lymphocytes in the blood. Hence there will be increased white cell numbers due to increase in lymphocytes.

  • How is it different from acute leukemia?

In acute leukemia, in addition to excessive proliferation the cells do not mature properly.

Whereas, in chronic leukemia, the cells proliferate but mature into normal cells.

Hence, unlike acute leukemia, the bone marrow function is not grossly deranged unlike acute leukemia.

Also, since the proliferation is not that rapid as that of acute leukemias, they do not need as aggressive treatment for acute leukemia.

  • Do all patients with chronic lymphocytic leukemia need be treated?

As mentioned earlier, since these cells proliferate slowly, many patients with chronic lymphocytic leukemia need not be treated immediately.

There are different criteria for starting treatment in these patients such as compromise of bone marrow function, massive lymphoid organ involvement etc. Your doctor will tell you if you need treatment.

  • Is the high white cell count in chronic lymphocytic leukemia dangerous?

There are patients who have slowly rising white cell counts, and in those patients even a white cell count of 100  x 109/L (Normal 3-10) may not be dangerous and would not require treatment, provided other parameters for treatment are not met.

This situation in different from acute leukemias, where high white cell count is often life threatening and would need urgent therapy.

  • What are the treatment options in chronic lymphocytic leukemia?

Depending on your age and stage of disease, treatment varies. It can be treated with simple tablets on elderly patients. Where as in middle aged patients, (55-70) various chemotherapy options are available. The purpose of treatment in these patients is to keep the disease under control as like in other low grade lymphomas. Usually the disease once treated, remains under control for few years, before it progresses again, at which time it can be treated with the same or different drugs depending on the condition.

This is the major difference between treatment of acute leukemia and chronic lymphocytic leukemia. In CLL, the aim of treatment is to keep the disease under control. Complete eradication of the disease is not required (Unless in young patients).

In young patients (30-55), especially if the disease is aggressive, in addition to initial chemotherapy, complete cure is possible with mini transplants.

  • What are the complications of chronic lymphocyte leukemia?

Chronic lymphocytic leukemia, in late stages can compromise the bone marrow function and can cause anemia and thrombocytopenia (low platelets)

Since lymphocytes are lodged in tiny spaces called lymph nodes, massive lymphnode enlargement can occur. Spleen is a lymphoid organ which may enlarge rapidly in some patients.

Since the lymphocytes are derived from malignant clone, they may suppress the growth of normal lymphocytes. Lymphocytes normally produce “immunoglobulins” which protect against infections. So, people with low immunoglobulin are prone for repeated infections. These people are benefited by immunoglobulin infusions.

  • What is the life span of patients with chronic lymphocytic leukemia?

The lifespan is determined by various factors such as stage of the disease, chromosomal changes etc.

Like low grade lymphomas (of course, CLL is a form of low grade lymphoma), this disease can be kept under control and treatment can be repeated whenever the disease comes back.

Good prognostic types can live as much as 10 years or more. In younger patients, the aim is for a complete cure so that they can lead a normal life span.

Department of Hemato oncology,

Amended on Dec 14th, 2014 @VNCC, GKNM by Dr Suthanthira kannan,

Amended on 2nd Nov, 2016 @ Coimbatore Kidney centre by Dr Suthanthira Kannan

 

 
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