Chronic Lymphocytic Leukemia Treatment in Delhi, India

Chronic lymphocytic leukemia (CLL) is a type of cancer affecting white blood cells, also known as lymphocytes. Patients suffering from CLL produce numerous abnormal lymphocytes in their bone marrows. It is a “chronic” condition, which means this disease spreads slowly, and it takes long before any appearance of symptoms.

CLL starts in the bone marrow, which is a spongy tissue in the center of the bones. Later, the abnormal lymphocytes spill out into the blood and spread to other organs, affecting their normal functioning.

Chronic Lymphocytic Leukemia Causes & Risk Factors

CLL occurs because of certain genetic changes in the cells of the bone marrow. The exact causes for such genetic mutation are unknown, but some risk factors are listed below:

• Age: Older people, especially those above 50 years of age, are more likely to get CLL. It is very rare in children.

• Family history: It is the history of CLL, any other leukemia, or blood or bone marrow diseases.

• Race: CLL is more prevalent in white people than in other ethnic groups.

• Chemicals: Exposure to certain chemicals such as Agent Orange used during the Vietnam War, and some pesticides and herbicides are associated with CLL.

Chronic Lymphocytic Leukemia Symptoms

CLL does not show any symptoms during its early stages. As the disease progresses, patients might observe some of the following signs and symptoms:

• Enlarged and swollen lymph nodes, most noticeably in the armpits, neck, stomach, or groin
• Recurrent infections and fevers
• Weight loss without any known reason
• Weakness and fatigue
• Night sweats
• Pain in the upper left portion of the abdomen because of the enlargement of the spleen
• Shortness of breath
• Loss of appetite

Stages of Chronic Lymphocytic Leukemia (CLL)

Following the diagnosis of CLL, staging determines the extent of spread of the disease and helps decide the best treatment approach:

Stage 0: In Stage 0 CLL, there are too many lymphocytes in the blood, but no apparent signs or symptoms of the disease.

Stage I: Stage I CLL shows the presence of abnormally high numbers of lymphocytes in the blood and the lymph nodes are enlarged.

Stage II: In Stage II CLL, the number of lymphocytes is abnormally higher, and the liver and spleen may also be enlarged, along with enlarged lymph nodes.

Stage III: Stage III CLL manifests by an abnormal increase in lymphocyte count in the blood, along with a decrease in red blood cell count. This may be accompanied by an enlarged liver, spleen, or lymph nodes.

Stage IV: In Stage IV CLL, there are abnormally high numbers of lymphocytes but low levels of platelets. The number of red blood cells may also be lower. The liver, spleen, and lymph nodes may be larger than normal.

Chronic Lymphocytic Leukemia Diagnosis and Tests

CLL is diagnosed with the help of the following tests:

Physical examination

To look for enlarged lymph nodes, liver, or spleen.

Blood tests

Complete blood count with a differential determines the number of different types of blood cells. An abnormally high lymphocyte count of more than 10,000 lymphocytes/mm3 is suggestive of CLL.

Blood chemistry tests such as basic metabolic panel, complete metabolic panel, kidney function test, liver function test, and electrolyte panel can also be used.

Flow cytometry

This test ascertains that numerous lymphocytes in the blood are because of cancer and not because of any other blood disorder or infection. Flow cytometry identifies certain markers present in CLL cells.

Bone marrow aspiration and biopsy

For bone marrow aspiration, a small sample of liquid marrow is obtained by injecting a needle into the bone. For a biopsy, a small amount of bone, marrow, and blood is taken. Both these tests are usually performed together to ascertain CLL diagnosis.

Imaging studies

CT scan, PET scan, or ultrasound may be obtained to look for the enlargement of body organs such as the liver or spleen, which is commonly observed in CLL.

Chronic Lymphocytic Leukemia Treatment

If a patient is in the early stages of CLL and is not showing any signs or symptoms, the patient’s doctor may not start treatment right away. No evidence is available to show that early treatment can prolong the life of a patient with CLL. Cancer treatments have certain side effects, so the patient’s physician will weigh the benefit and risk ratio, and make an appropriate treatment schedule for the patient.

Following are the treatment options for intermediate to advanced stages of CLL:

Chemotherapy

Chemotherapy drugs kill rapidly growing cells, including cancer cells. A patient can be prescribed a single or a combination of chemotherapy drugs depending upon clinical condition.

Immunotherapy

Immunotherapy modifies our body’s immune system in such a way that it can identify and kill cancer cells.

Monoclonal antibodies

These are man-made versions of antibodies that are designed to attach to specific targets, such as a protein on the cell wall of cancer cells and destroy it.

Targeted drug therapy

These drugs target the abnormality within a cell that turns them into cancerous cells. Targeted drug therapy is generally given as the first line of treatment for CLL.

Bone marrow transplant

Strong chemotherapy drugs are used to kill stem cells that are producing abnormal lymphocytes. Following this, healthy donor blood stem cells are transplanted, which produce healthy blood cells.

Prognosis of Chronic Lymphocytic Leukemia (CLL)

The prognosis of CLL is much better as compared to other types of cancers. Though it varies with age and the stage of the disease, the five-year survival rate of patients with CLL is greater than 80%

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