Chronic lymphocytic leukemia (CLL)

Introduction

Chronic lymphocytic leukemia is a malignant blood disease accompanied by excessive production of mature but deficient B-type lymphocytes and their accumulation in the spleen, liver, and lymph nodes. At the same time, a deficiency of red blood cells develops, accompanied by symptoms of anemia and platelets, as a result of which the patient begins to suffer from excessive bleeding. Chemotherapy and bone marrow transplantation are used for treatment.

About the disease

Chronic lymphocytic leukemia is more common in adults over 40 years of age, although there is a recent trend towards rejuvenation of the disease. Men suffer more often than women. The peak of morbidity occurs at the age of 50-70 years. Pathology belongs to the group of non-Hodgkin’s lymphomas. The disease can proceed as virtually asymptomatic and immediately manifest itself with vivid symptoms and lead to death within 2-3 years from the moment of manifestation.

Classification of chronic lympholeukemia

Hematologists distinguish several forms of chronic lymphocytic leukemia, differing in the speed of development, symptomatology, and response to treatment:

classic (progressive) form: signs increase over several months;
lymphocytic leukemia with a benign course: characterized by a slow increase in changes in the general blood count, and several years or several decades pass between the first signs of the disease and a noticeable impact on the quality of life;
tumor form: characterized by a significant increase in lymph nodes against the background of small changes in the general blood count;
medullary form: lymph nodes, spleen, and liver are not affected; in the blood test, there is a pronounced cellular deficit;
lymphocytic leukemia with enlarged spleen;
lymphocytic leukemia with paraproteinemia: characterized by the accumulation of abnormal immunoglobulins in the blood and tissues;
Pre-lymphocytic form: characterized by the presence of atypical lymphocytes containing nucleoli in the blood and bone marrow;
Hairy cell leukemia: there is a deficiency of blood cells in combination with an enlarged spleen, and microscopic examination of samples reveals characteristic changes in the structure of lymphocytes; their cytoplasm has irregular “pile-like” edges;
T-cell form: a rare form characterized by skin lesions and rapid progression.

In the course of chronic lymphocytic leukemia, there are three stages:

initial: no symptoms; pathology is detected only by laboratory examination;
stage of advanced clinical manifestations: symptomatology becomes vivid and noticeable;
terminal: the patient’s condition worsens, multiple organ dysfunctions occur, leading to death.

Symptoms of chronic lymphocytic leukemia

The severity of signs of chronic lymphocytic leukemia depends on the stage of the disease. Initially, the patient does not note any changes in well-being or in the state of the lymph nodes. With the progression of pathology and transition to the stage of advanced manifestations, characteristic symptoms of the disease appear:

lymph node enlargement, most often affecting axillary and cervical nodes, then the disease affects the nodes in the chest and abdomen, and finally – inguinal. Lymph nodes are painless when palpated, not adhered to the surrounding tissues, and easily displaced relative to them; individual elements can reach 5 cm in diameter and more;
enlargement of the liver, spleen, and other internal organs, often accompanied by signs of compression of neighboring structures;
weakness, fatigue, and decreased efficiency.

As the disease progresses, the symptoms become more pronounced. To the already existing problems are added sweating, especially pronounced at night, a slight but prolonged rise in temperature, increased susceptibility to colds, infections of the skin and subcutaneous tissue, and urinary tract infections.

When moving to the terminal stage, the course of the disease is complicated by pleurisy, inflammation of the lungs, generalized skin infections, lesions of the brain and spinal cord, and heart muscle.

Causes of chronic lymphocytic leukemia

The causes of the pathology have not been determined. Moreover, so far, doctors have not been able to reliably prove the connection between the disease and exposure to carcinogens (ionizing radiation, toxins, etc.). At present, the most probable risk factor is hereditary pathology.

Diagnosis of chronic lymphocytic leukemia

The diagnosis of chronic lymphocytic leukemia is based on the results of blood tests, which show an increase in the number of lymphocytes mainly due to the accumulation of atypical forms. In addition, cytogenetic examinations, bone marrow puncture, and examination of lymph nodes and internal organs using ultrasound, CT, MRI, and other imaging methods are performed.

Treatment of chronic lymphocytic leukemia

The choice of treatment method for chronic lymphocytic leukemia in adults depends on the severity of symptoms, diagnostic results, and the form of the disease. If the pathology is detected at the initial stages and there are no signs of pathology, doctors use a surveillance tactic with regular patient examinations every 3-6 months. If the number of leukocytes increases, chemotherapy is prescribed, and if it is ineffective – bone marrow transplantation. If the course of the disease involves an autoimmune component, corticosteroids are prescribed. In case of significant enlargement of the spleen, liver, or lymph nodes, targeted radiation therapy is used.

Symptomatic treatment may include:

red blood cell or platelet transfusion (for anemia or thrombocytopenia, respectively);
antibacterial, antiviral, or antifungal therapy as needed;
removal of the spleen in case of its significant enlargement, etc.

Treatment lasts, on average, about 8-12 months and is discontinued when the patient’s condition improves. If symptoms progress again, therapy is resumed.

All these treatment options are available in more than 750 hospitals worldwide (https://doctor.global/results/diseases/chronic-lymphocytic-leukemia-cll). For example, splenectomy can be done in 12 clinics across Turkey for an approximate price of $6.3 K (https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/splenectomy).

Prevention

There are no specific preventive measures for chronic lymphocytic leukemia. Regular screening examinations, including a general blood test, are recommended for timely pathology detection.

Rehabilitation

Chronic lymphocytic leukemia cannot be completely cured. If remission is achieved, a hematologist should regularly examine the patient, avoid excessive insolation and exposure to toxins, and lead a healthy lifestyle.