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FAQ for Chronic Lymphocytic Leukemia

What is Chronic Lymphocytic Leukemia ?

Chronic lymphocytic leukemia, often referred to as CLL, is a type of cancer of the blood. It is one of a group of diseases that affects a type of white blood cell called a lymphocyte. The lymphocytes help the body fight infection.
In CLL, abnormally high numbers of ineffective (useless) lymphocytes are found in the blood and/or bone marrow (the spongy area in the middle of large bones where blood cells are formed). They cannot fight infection as normal lymphocytes do, and collect in increased numbers in lymph nodes and other areas, such as the liver and spleen. Their high numbers can cause them to interfere with the proper production of other blood cells, such as red cells and platelets. 
CLL is usually characterized by a slow progression of the disease and related symptoms. In many cases, it causes the patient little, if any, problems in its early stages.Patients may live with CLL for many, many years.

What are its symptoms ?

Many patients donot have any symptoms, as it is diagnosed on a routine blood count for some other condition. Symptoms of CLL depend on the stage of the disease (stage determines the severity of the disease). Some of the symptoms include:

Lymphnode enlargement: It can occur in the neck, armpits or the groins. It is occurs in the abdomen (tummy) it can present with a swelling in the tummy.

Night sweats, weight loss and loss of appetite (not feeling like eating).

Tiredness, loss of energy and shortness of breath due to low haemaoglobin (Anaemia).

Repeated infections due to low neutrophil (a type of white cell in blood necessary to fight infection) count. It can present with boils, skin infections and chest infections etc.

Bleeding, bruising due to low platelet count

How is CLL staged?

The natural history of CLL may vary considerably from person to person. Some patients may become sick within a short time of diagnosis; others live comfortably for many years without problems. Determining which patients are most likely to get sick, and therefore are most likely to benefit from treatment of the disease, has been a challenge for doctors.

When will I need treatment ?

Treatment is not always required for CLL. Although treatment can be effective in controlling progression of the disease and alleviating symptoms, it usually does not produce a cure. This means that doctors and patients must carefully weigh the risks and discomforts of treatment against expected benefits to be gained.
However, there are certain groups of patients in whom some type of treatment is generally indicated. This includes patients with:

Anemia and/or low platelets

Disease-related symptoms such as weakness, night sweats, weight loss, painful lymph node swelling, or fever

Progressive disease, as demonstrated by rapidly increasing white cells in the blood, and/or rapidly enlarging lymph nodes, spleen, or liver

Repeated infections

What are the treatment options for CLL?

Chemotherapy:

Chemotherapy, or the use of medications to kill cancer cells, can be effective in treating CLL.The following three agents were among the first to be successfully used for the treatment of CLL

Chlorambucil:

This is taken by mouth either daily or in a single dose given every three to four weeks. The most common side effects are anaemia, low white blood cell counts (leading to risk for infection), and low platelet counts (increasing the risk for bleeding).

Cyclophosphamide :

This medicine can be given by mouth or through an intravenous (IV) line. Side effects include low blood counts, nausea and vomiting, hair loss, and irritation of the urinary bladder.

Steroids:

Some treatment programs call for the use of steroids such as prednisone to treat CLL. Side effects include increased susceptibility to infections, high blood glucose, stomach ulcers, muscle weakness, and psychiatric symptoms.

Newer agents

The following two agents have been shown to be effective in CLL. Fludarabine with or without combination with cyclophosphamide, is the most potent combination regimen developed to date.

Fludarabine:

It can be given via a vein or orally. Major side effects are low blood counts and fever. Older patients seem to be more prone to serious side effects from this medicine, including an increased risk of severe infections.

Cladribine :

This is a medicine similar to fludarabine, with similar side effects.

Other treatment options:

Monoclonal antibodies :

Medicines called monoclonal antibodies may help treat CLL by attacking specific substances (antigens) on the surface of the leukemic cells. Examples include rituximab and alemtuzumab.

Radiotherapy:

Radiation therapy may be used to shrink large, bulky masses of lymphoid tissue that occur because of accumulation of leukaemic cells. These cells are very responsive to radiation and usually shrink considerably, although the swelling may return. The spleen or other areas of the body may be treated.

Bone marrow transplantation:

Bone marrow transplantation (also called hematopoietic stem cell transplantation) is being more seriously considered as a therapy for CLL, especially for patients below the age of 55. After the treatment, the patient needs to have a healthy supply of very young blood cells, called stem cells, reintroduced, or transplanted. The transplanted cells then reestablish the blood cell production process in the bone marrow.

What are the complications of the treatment?

The major complications of CLL are caused by the low blood counts and immune system problems that either arises from the disease itself or the treatment. They include infection, anaemia, and low platelets.

Infection:

Episodes of infection are major complications that occur during the treatment of CLL Infections of the upper respiratory tract are common, but usually respond to antibiotics. Patients treated with certain chemotherapy agents may develop low white blood cells counts, and an increased risk of other infections. Early treatment with antibiotics is recommended, and, in some cases, medications that promote the growth of new blood cells may be given to boost the white cell count and decrease the infection risk.

Anaemia:

Anaemia (Low Haemoglobin) is common in CLL. Patients with anaemia may experience fatigue, weakness, and chest pain. Treatment includes blood transfusion. Other forms of anaemia may be treated with steroids.

Bleeding:

It occurs due to low platelets count. Patients with CLL and low platelet counts may see their counts improve with treatment of the CLL. In some cases, platelet transfusions are needed.

What is the prognosis (outcome)?

It will be discussed with you in detail by your haematologist and differs for each patient

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