Chronic Lymphocytic Leukaemia
About the Condition
Leukaemia is cancer of the white blood cells. The term chronic leukaemia is used to describe the type of cancer that tends to progress slowly over the course of many years; people with chronic leukaemia often show few symptoms for many years. This means that the condition is often diagnosed coincidentally, during routine check-ups or blood tests for other issues.
Chronic leukaemia is further classified according to the type of white blood cells affected by cancer - chronic lymphocytic leukaemia (CLL) affects the lymphocyte cells.
All types of leukemia originate in the bone marrow, which is the spongy material found inside bones and contains a specialised type of cell called stem cells.
These stem cells can develop into any of the three types of blood cell:
- red blood cells – which carry oxygen around the body
- white blood cells – which help fight infection
- platelets – which help stop bleeding
In CLL, the stem cells start overproducing white blood cells that aren't fully developed, which are called lymphocytes. These immature lymphocytes are much less effective at fighting bacteria and viruses, making the body more vulnerable to infection. This overproduction of lymphocytes is at the expense of the other blood cells, and it's this lack of red blood cells and platelets that can cause symptoms of anaemia, such as tiredness, as well as increasing the likelihood of excessive bleeding.
Of the 8,600 cases of leukaemia are diagnosed in the UK each year, about 3,200 are CLL*.
CLL is more common in older people, with most cases occurring in people over 60 years of age*. It's rare in people who are under 40 and almost never occurs in children*. For reasons that are unknown, men are more likely to develop chronic lymphocytic leukaemia than women.
The causes of CLL are unclear, but there are a variety of known risk factors for the disease, which include:
- having a family history of the condition
- being of European, American or Australian origin (it's rare in people from China, Japan and South East Asia)
- having certain medical conditions, including:
- pneumonia (chest infection)
- autoimmune haemolytic anaemia
- long term (chronic) osteoarthritis
- prostatis (an ibflamed prostate)
- any condition that lowers immunity, such as HIV or AIDS
- any organ transplant that requires the taking of immunosuppressants
In its early stages, chronic lymphocytic leukaemia doesn't usually cause any noticeable symptoms. As the condition develops, symptoms can include:
- repeated infections that occur over a short space of time
- tiredness due to a lack of red blood cells (anaemia)
- unusual bleeding and bruising
- night sweats
- bone pain
- weight loss
- swollen spleen
- swollen lymph nodes (glands)
If any of these symptoms apply to you, or if you have any concerns about similar symptoms, it is essential that you see your doctor at once, as your chances of recovery are much higher if your cancer is diagnosed early.
If you are referred to CCL for diagnosis, your consultant or oncologist will advise you as to which tests are relevant, however most cases of chronic lymphocytic leukaemia are discovered during unrelated routine blood tests. Once CLL is suspected, or if any symptoms are shown, tests to diagnose include:
- A physical examination to check for swollen glands, a swollen spleen or any signs of abnormal bleeding
- A blood test, to measure the numbers of different types of blood cell
- A Computerised Tomography (CT) scan, which shows a 3D image of the area being looked at
- An X-ray, which is when low level radiation is used to create an image of the body
- An Ultrasound scan, which uses high frequency sound waves to look inside the body and produce live images on a computer display.
- A bone marrow biopsy, during which a haematologist will take a small sample of bone marrow to examine under a microscope. This involves inserting a needle into a large bone, usually the hip bone, to extract the marrow, and is done under local anaesthetic
- Genetic testing, such as Fluorescence In Situ Hybridisation (FISH) can also be carried out on blood and bone marrow samples to help identify abnormalities in the leukaemia genes. Doctors are able to use FISH to identify abnormal genes in the cells of about 80% of people with chronic lymphocytic leukaemia. Identifying gene abnormalities in this way is very useful because it allows treatments to be targeted more effectively.
- A lymph node biopsy, where samples are taken from any enlarged lymph nodes to attempt to discover which specific strain of CLL is present, to further the efficiency of treatment.
Doctors use stages to describe how far leukaemia has developed, and to help when deciding on treatment. In the UK, the Binet staging system is used for chronic lymphocytic leukaemia. It has three stages:
- Stage A – where there are fewer than three areas of enlarged lymph nodes and a high white blood cell count
- Stage B – where there are more than three areas of enlarged lymph nodes and a high white blood cell count
- Stage C – where there are enlarged lymph nodes or spleen, a high white blood cell count and a low red blood cell or platelet count
An area of lymph nodes refers to lymph nodes in one area of the body, such as the neck, under the arms or in the groin. If the lymph nodes on both sides of the body are swollen under both arms, for example – this counts as one area.
At CCL, patients with CLL are treated by a team of different specialists, called a Multi-Disciplinary Team, or MDT, from our Haemato-Oncology department, headed by Professor Ray Powles, CBE. This team works together to create a treatment plan to suit the individual needs of the patient. As most people diagnosed with chronic lymphocytic leukaemia don't have symptoms, immediate treatment isn't usually recommended. Some people can live for years or decades with chronic lymphocytic leukaemia without developing symptoms or needing treatment, as there is no advantage to starting treatment before symptoms appear.
In such cases, a policy of "watchful waiting" is usually recommended, which involves regular visits to your doctor and blood tests so that your condition can be closely monitored.
Treatment for chronic lymphocytic leukaemia will usually only be recommended if you have:
- symptoms, such as severe tiredness and weight loss
- enlarged lymph nodes
- bone marrow failure
- rapidly rising numbers of lymphocytes (white blood cells) in your bloodstream
Once symptoms are present, treatment usually involves:
- Radiotherapy, which is where high-energy rays are used to destroy the cancer cells.
- Chemotherapy, which involves the use of chemical agents which are toxic to cancer cells, destroying them and preventing them from spreading to different areas. This can be given by injection or in tablet form.
- A bone marrow or stem cell transplant, which is a possible alternative if chemotherapy has been unsuccessful. Before transplantation can take place, the patient will need to have intensive high-dose chemotherapy and radiotherapy to destroy the cells in their bone marrow. The donated stem cells are then given through a tube into a blood vessel, in a similar way to chemotherapy medication.
Treatment can't cure chronic lymphocytic leukaemia completely, but it can slow its progression and lead to remission (periods where there are no signs or symptoms).
Cancer doesn’t just leave a physical impact on an individual, it can have a huge emotional effect as well. Cancer and its treatment can be overwhelming, causing a wide variety of emotions, and it is important to remember that there is no right or wrong response. Reactions vary hugely from person to person, and most people find that it becomes easier to cope when they’re given additional support, so that’s what we do.
At CCL we provide support that caters to both the physical and emotional needs of the patient, before, during and after treatment. We offer a wide range of services for patients, as well as their loved ones, designed to make a very difficult time as easy as possible, and to give our patients the best treatment and support possible.
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