Chronic lymphocytic leukaemia

People with chronic lymphocytic leukaemia (CLL) 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 leukaemia originate in the bone marrow, which is the spongy material found inside bones and contains a specialised type of cell called stem cells.

Risks and causes of chronic lymphocytic leukaemia

The cause or causes of chronic lymphocytic are unknown, but it is more common in older people, with most cases occurring in people over 60 years of age*. For reasons that are unknown, men are more likely to develop chronic lymphocytic leukaemia than women.

Symptoms of chronic lymphocytic leukaemia

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
• Fever
• 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.

How is chronic lymphocytic leukaemia diagnosed?

Once chronic lymphocytic leukaemia 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
• Blood test: to measure the numbers of different types of blood cell
• CT scan: which shows a 3D image of the area being looked at
• X-ray: low-level radiation is used to create an image of the body
• Ultrasound: uses high-frequency sound waves to look inside the body and produce live images on a computer display
• Bone marrow biopsy: a haematologist will take a small sample of bone marrow to examine under a microscope
• 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
• 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

Chronic lymphocytic leukaemia treatment

Patients with chronic lymphocytic leukaemia are treated by a specialist multidisciplinary team. 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.

Once symptoms are present, treatment usually involves:

• Radiotherapy is where high-energy rays are used to destroy the cancer cells
• Chemotherapy 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 is a possible alternative if chemotherapy has been unsuccessful

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).