Chronic lymphocytic leukemia

Subject: Chronic lymphocytic leukemia Thu Jan 20, 2011 4:15 pm

Chronic lymphocytic leukemia
Filed under: Cancer & Chemo
Chronic lymphocytic leukemia (CLL) is a type of cancer of the blood and
bone marrow — the spongy tissue inside bones where blood cells are made.

The term "chronic" in chronic lymphocytic leukemia comes from the fact
that it typically progresses more slowly than other types of leukemia.
The term "lymphocytic" in chronic lymphocytic leukemia comes from the
cells affected by the disease — a group of white blood cells called
lymphocytes, which help your body fight infection.

Chronic lymphocytic leukemia most commonly affects older adults. Chronic
lymphocytic leukemia treatments can help control the disease.

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Symptoms

Many people with chronic lymphocytic leukemia have no symptoms. Those who do develop signs and symptoms may experience:

* Enlarged, but painless, lymph nodes
* Fatigue
* Fever
* Pain in the upper left portion of the abdomen, which may be caused by an enlarged spleen
* Night sweats
* Weight loss
* Frequent infections

When to see a doctor
Make an appointment with your doctor if you're concerned about any of your signs and symptoms.

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Causes

Doctors aren't certain what starts the process that causes chronic
lymphocytic leukemia. Doctors know that something happens in order to
cause a genetic mutation in the DNA of blood-producing cells. This
mutation causes the blood cells to produce abnormal, ineffective
lymphocytes — one type of white blood cell that helps your body fight
infection.

Beyond being ineffective, these abnormal lymphocytes continue to live
and multiply, when normal lymphocytes would die. The abnormal
lymphocytes accumulate in the blood and certain organs, where they cause
complications. They may crowd healthy cells out of the bone marrow and
interfere with normal blood cell production.

Doctors and researchers are working to understand the exact mechanism that causes chronic lymphocytic leukemia.

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Risk factors

Factors that may increase the risk of chronic lymphocytic leukemia include:

* Your age. Most people diagnosed with chronic lymphocytic leukemia are over 60.
* Your sex. Men are more likely than are women to develop chronic lymphocytic leukemia.
* Your race. Whites are more likely to develop chronic lymphocytic leukemia than are people of other races.
* Family history of blood and bone marrow cancers. A family history
of chronic lymphocytic leukemia or other blood and bone marrow cancers
may increase your risk.
* Exposure to chemicals. Certain herbicides and insecticides,
including Agent Orange used during the Vietnam War, have been linked to
an increased risk of chronic lymphocytic leukemia.

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Complications

Chronic lymphocytic leukemia may cause complications such as:

* Frequent infections. People with chronic lymphocytic leukemia may
experience frequent infections. In most cases, these infections are
common infections of the upper and lower respiratory tract. But
sometimes more-serious infections can develop.
* A switch to a more aggressive form of cancer. A small number of
people with chronic lymphocytic leukemia may develop a more aggressive
form of cancer called diffuse large B-cell lymphoma. Doctors sometimes
refer to this switch as Richter's syndrome.
* Increased risk of other cancers. People with chronic lymphocytic
leukemia have an increased risk of other types of cancer, including skin
cancer, such as melanoma, and cancers of the lung and the digestive
tract.
* Immune system problems. A small number of people with chronic
lymphocytic leukemia may develop an immune system problem that causes
the disease-fighting cells of the immune system to mistakenly attack the
red blood cells or the platelets.

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Preparing for your appointment

If you have any signs or symptoms that worry you, start by making an
appointment with your family doctor or a general practitioner. If your
doctor determines you may have chronic lymphocytic leukemia, you may be
referred to a doctor who specializes in diseases of the blood and bone
marrow (hematologist).

Because appointments can be brief, and because there's often a lot of
ground to cover, it's a good idea to be well prepared. Here's some
information to help you get ready, and what to expect from your doctor.

What you can do

* Be aware of any pre-appointment restrictions. At the time you make
the appointment, ask if there's anything you need to do in advance,
such as restrict your diet.
* Write down key personal information, including any major stresses or recent life changes.
* Make a list of all medications, as well as any vitamins or supplements, that you're taking.
* Take a family member or friend along. Sometimes it can be
difficult to absorb all the information provided during an appointment.
Someone who accompanies you may remember something that you missed or
forgot.
* Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions
will help you make the most of your time together. List your questions
from most important to least important in case time runs out. For
chronic lymphocytic leukemia, some basic questions include:

* What do my test results mean?
* Do I need treatment right away?
* If I don't begin treatment right now, will that limit my treatment options in the future?
* Should I undergo additional tests?
* What are my treatment options?
* What are the side effects associated with each treatment?
* Is there one treatment that's strongly recommended for someone with my diagnosis?
* How will treatment affect my daily life?
* Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

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Tests and diagnosis

Blood tests
Tests and procedures used to diagnose chronic lymphocytic leukemia include blood tests designed to:

* Count the number of cells in a blood sample. A complete blood
count may be used to count the number of lymphocytes in a blood sample. A
high number of B cells, one type of lymphocyte, may indicate chronic
lymphocytic leukemia.
* Determine the type of lymphocytes involved. A test called flow
cytometry or immunophenotyping helps determine whether an increased
number of lymphocytes is due to chronic lymphocytic leukemia, a
different blood disorder or your body's reaction to another process,
such as infection. If chronic lymphocytic leukemia is present, flow
cytometry may also help analyze the leukemia cells for characteristics
that help predict how aggressive the cells are.
* Analyze lymphocytes for genetic abnormalities. A test called
fluorescence in situ hybridization (FISH) examines the chromosomes
inside the abnormal lymphocytes to look for abnormalities. Doctors
sometimes use this information to determine your prognosis and help
choose a treatment.

Other tests
In some cases your doctor may order additional tests and procedures to aid in diagnosis, such as:

* Bone marrow biopsy and aspiration
* Computerized tomography

Staging
Once a diagnosis is confirmed, your doctor determines the extent (stage)
of your chronic lymphocytic leukemia. Two different staging systems are
used. Each assigns a stage — early, intermediate or advanced — that
indicates the progression of a person's chronic lymphocytic leukemia.
These levels are used to determine your treatment options.

In general, people with early-stage disease don't require immediate
treatment. Those with intermediate-stage disease and advanced-stage
disease may be given the option to begin treatment right away.

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Treatments and drugs

Your treatment options for chronic lymphocytic leukemia depend on
several factors, such as the stage of your cancer, whether you're
experiencing signs and symptoms, your overall health, and your
preferences.

Treatment may not be necessary in early stages
People with early-stage chronic lymphocytic leukemia typically don't
receive treatment, though clinical trials are evaluating whether early
treatment may be helpful. Studies have shown that early treatment
doesn't extend lives for people with early-stage chronic lymphocytic
leukemia. Rather than put you through the potential side effects and
complications of treatment before you need it, doctors carefully monitor
your condition and reserve treatment for when your leukemia progresses.
Doctors call this watchful waiting.

Your doctor will plan a checkup schedule for you. You may meet with your
doctor and have your blood tested every few months to monitor your
condition.

Treatments for intermediate and advanced stages
If your doctor determines your chronic lymphocytic leukemia is
progressing or is in the intermediate or advanced stages, your treatment
options may include:

* Chemotherapy. Chemotherapy is a drug treatment that kills cancer
cells. Chemotherapy treatments can be given through a vein in your arm
or taken in pill form. Depending on your situation, your doctor may use a
single chemotherapy drug or you may receive a combination of drugs.
Side effects depend on what chemotherapy drugs are used. Common side
effects include fatigue, low blood cell counts and a risk of frequent
infections.
* Targeted drug therapy. Targeted drugs are designed to take
advantage of the specific vulnerabilities of your cancer cells. Chronic
lymphocytic leukemia cells have a variety of proteins on their surfaces.
Targeted therapy drugs are designed to bind to a specific protein as a
way to target and kill leukemia cells. Targeted therapy drugs used in
treating chronic lymphocytic leukemia include rituximab (Rituxan),
alemtuzumab (Campath) and ofatumumab (Arzerra). Side effects of these
drugs include fever, chills and infections.
* Bone marrow stem cell transplant. Bone marrow stem cell
transplants use strong chemotherapy drugs to kill the stem cells in your
bone marrow that are creating diseased lymphocytes. Then healthy adult
blood stem cells from a donor are infused into your blood, where they
travel to your bone marrow and begin making healthy blood cells. A
reduced intensity, or "mini," bone marrow stem cell transplant is
similar to a standard stem cell transplant, but it uses lower doses of
chemotherapy drugs. Bone marrow stem cells may be a treatment option for
people who aren't helped by other treatments or for certain people with
very aggressive chronic lymphocytic leukemia.

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Lifestyle and home remedies

You can take steps to keep your body healthy if you've been diagnosed with chronic lymphocytic leukemia. Try to:

* Do what you can to avoid infections. People with chronic
lymphocytic leukemia are prone to frequent infections. Take steps to
keep yourself healthy. Eat a healthy diet with plenty of fruits and
vegetables. Get enough sleep so that you wake feeling rested. Exercise
most days of the week. Do your best to avoid people who are sick. Wash
your hands frequently and thoroughly to help keep germs away. Keep up to
date on your immunizations, including an annual flu shot.
* Reduce your risk of second cancers. People with chronic
lymphocytic leukemia have a risk of second cancers. Lifestyle changes
may help reduce your risk, such as not smoking, and drinking alcohol in
moderation, eating a healthy plant-based diet and using sunscreen when
you're outside.
* Go to all of your appointments. Frequent blood tests to see if
your cancer has progressed can wear on you. Each time you go for your
test, you may worry that your cancer is worsening. Don't let this stop
you from going to your appointments. Instead, expect that you'll have
some concern and plan for it. Find relaxing activities while waiting for
test results. For instance, exercise, read, or spend time with friends
and family.

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Alternative medicine

No alternative treatments have been proved to cure chronic lymphocytic leukemia.

Alternative treatments for coping with fatigue
Some alternative medicine therapies may help you cope with fatigue,
which is commonly experienced by people with chronic lymphocytic
leukemia. Your doctor can treat fatigue by controlling the underlying
causes, but often medications alone aren't enough. You may find relief
through alternative therapies, such as:

* Exercise
* Massage
* Meditation
* Relaxation techniques
* Yoga

Talk to your doctor about your options. Together you can devise a plan to help you cope with fatigue.

Green tea extracts for people with early-stage leukemia
A green tea extract has shown some promise in treating chronic
lymphocytic leukemia (CLL). Laboratory research determined that a
compound in green tea extract, called EGCG, can kill CLL cells. In a
study of people with early-stage chronic lymphocytic leukemia, taking
EGCG in pill form reduced some signs of the disease in a portion of the
participants. For instance, some participants noticed that their
enlarged lymph nodes decreased in size and blood tests revealed some
participants had fewer leukemia cells in their blood. Research into EGCG
and green tea is ongoing.

EGCG is generally considered safe, though, at high doses, it can cause
complications, such as liver problems, and it may interfere with some
medications. Side effects can include nausea, abdominal pain and
indigestion. If you're interested in trying EGCG, talk with your doctor
about the risks and benefits.

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Coping and support

Chronic lymphocytic leukemia is typically a slow-growing cancer that may
not require treatment. While some people may refer to this as a "good"
type of cancer, it doesn't really make receiving a cancer diagnosis any
easier. While you may initially be shocked and anxious about your
diagnosis, you'll eventually find your own way of coping with chronic
lymphocytic leukemia. Until then, try to:

* Find out all you can about chronic lymphocytic leukemia. Write
down questions to ask your doctor before each appointment and look for
information in your local library and on the Internet. Good sources
include the National Cancer Institute, the American Cancer Society and
The Leukemia & Lymphoma Society.
* Connect with other cancer survivors. A support group of people
with the same diagnosis can be a source of useful information, practical
tips and genuine encouragement. Ask your health care team about support
groups in your area. Or go online. The American Cancer Society and The
Leukemia & Lymphoma Society both host online message boards for
cancer survivors.
* Lean on friends and family. It can be tough to talk about your
diagnosis, and you'll likely get a range of reactions when you share the
news. But talking about your diagnosis can be helpful. So can the
practical help that often results. You'll likely get many offers to
help. Plan ahead and think of ways you'd like your friends and family to
help. For instance, ask someone to drive you to an appointment, help
with chores or just listen when you want to talk.
* Explore ways to cope with the nagging, chronic nature of the
disease. If you have chronic lymphocytic leukemia, you'll likely face
ongoing tests and ongoing worries about your white blood cell count. Try
to find some activities that help you relax, whether it's yoga,
exercise or gardening. Talk to a counselor, therapist or oncology social
worker if you need help dealing with the emotional challenge of this
chronic disease.

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