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About leukemia
Leukemia is a cancer of the blood. Leukemia begins when
normal blood cells change and grow uncontrollably. Chronic
lymphocytic leukemia (CLL) is a cancer of the lymphocytes, a
type of white blood cell involved in the bodys immune system.
In some people with CLL, the disease grows and progresses
slowly, and it may take years for symptoms to appear or for
treatment to be needed. In fact, some patients may never need
treatment for their CLL. In other patients the disease grows
more quickly and needs treatment sooner.
About lymphocytes
Lymphocytes circulate in the bloodstream and are made in the
lymph nodes, spleen, thymus, and bone marrow. Bone marrow
is the spongy, red tissue in the inner part of the large and flat
bones. There are three different types of lymphocytes: T cells,
B cells, and natural killer (NK) cells. Generally, T cells fight
infections by triggering other cells in the immune system and
by destroying infected cells, B cells make antibodies, and NK
cells fight microbes and cancer cells.
About CLL
In people with CLL, the abnormal cells crowd other types of cells in the bone marrow,
preventing the production of red blood cells that carry oxygen, other types of normal
white blood cells, such as neutrophils or granulocytes that fight infection, and platelets
that are needed for clotting. This means that people with CLL may have anemia from
low levels of red blood cells, are more likely to get infections because they do not have
enough white blood cells, and bruise or bleed easily because of a low level of platelets.
There are two general types of CLL, and it is important for doctors to find out whether
the disease is caused by the overgrowth of T cells or B cells. The T-cell type of CLL is
now called T-cell prolymphocytic leukemia and much less common than the B-cell type
of the disease. About 1% of people with CLL have the T-cell type. More than 95% of
people with CLL have the B-cell type.
Most often, CLL is diagnosed when too many abnormal lymphocytes are found in the
blood, also known as lymphocytosis. However, the same disease can occur when the
abnormal lymphocytes are mostly in the lymph nodes but not in the blood. This is called
small lymphocytic lymphoma, but it behaves very similarly to CLL.
Leukemia - Chronic Lymphocytic - CLL - Statistics
This year, an estimated 15,720 people of all ages (9,100 men and 6,620 women) in the
United States will be diagnosed with CLL. Children are almost never diagnosed with
CLL, but it is the most common type of leukemia diagnosed in adults. It is estimated
that 4,600 deaths (2,800 men and 1,800 women) from CLL will occur this year.
The survival rate for people with CLL varies widely according to the stage of the
disease and can range from about one year to more than 20 to 30 years. The five-year
survival rate is the percentage of people who survive at least five years after the cancer
is detected, excluding those who die from other diseases. The five-year survival rate of
people with CLL is about 79%.
Imaging tests. CLL is generally found in many parts of the body, even if
the disease has been diagnosed early. Imaging tests are rarely needed to
diagnose CLL. They are sometimes used before treatment to find all parts
of the body that are affected by CLL or to find out whether particular
symptoms may be related to CLL. Imaging tests may also be used to see
how well treatment is working.
An x-ray is a way to create a picture of the structures inside of the body,
using a small amount of radiation. It may show if cancer is growing in
lymph nodes in the chest.
A computed tomography (CT or CAT) scan creates a three-dimensional
picture of the inside of the body with an x-ray machine. A computer then
combines these images into a detailed, cross-sectional view that shows
any abnormalities. It can detect lymph nodes with CLL around the heart,
windpipe, lungs, abdomen, and pelvis. A CT scan can also be used to
measure the size of the lymph nodes. Sometimes, a special dye called a
contrast medium is given before the scan to provide better detail on the
image. This dye can be injected into a patients vein or given as a liquid to
swallow. CT scans can also help find out if CLL is in other organs, such
as the spleen.
Positron emission tomography (PET) scans have not been proven to be
helpful in diagnosing or staging CLL.
Targeted therapy
Targeted therapy is a treatment that targets the leukemias specific genes,
proteins, or the tissue environment that contributes to its growth and survival. This
type of treatment blocks the growth and spread of leukemia cells while limiting
damage to healthy cells.
Monoclonal antibodies. A monoclonal antibody is a type of targeted therapy. It is
directed against a specific protein in the surface of leukemia cells, and it does not
affect cells that do not have that protein.
Rituximab is a monoclonal antibody given intravenously, that binds to a protein on
the surface of B cells, destroying some of the CLL cells and also making
chemotherapy more effective. As mentioned above, rituximab is currently being
used in combination with chemotherapy.
Alemtuzumab (Campath) is another monoclonal antibody that has been approved
by the U.S. Food and Drug Administration (FDA) as a treatment for advanced CLL
when other treatments no longer work. It can be used for both T-cell and B-cell
CLL. This antibody can be given either intravenously or as an injection under the
skin. Similarly, two new antibodies called ofatumumab (Arzerra) and obinituzumab
(Gazyva) have recently been approved for the treatment of CLL.
Kinase inhibitors. Ibrutinib (Imbruvica) is a drug called a kinase inhibitor that is
given orally which targets Brutons tyrosine kinase, an important factor influencing
the growth of B cells. Kinases are enzymes found in both normal cells and cancer
cells. Some cancer cells can be destroyed by drugs that block this particular
kinase enzyme. Ibrutinib is approved by the FDA for patients with CLL who have
already received at least one other treatment.
Idelalisib (Zydelig) is another type of kinase inhibitor. It is approved by the FDA in
combination with rituximab for patients with CLL that comes back after treatment
when rituximab alone would be considered appropriate therapy; see more below.
Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer
cells. A doctor who specializes in giving radiation therapy to treat cancer is called a
radiation oncologist. However, radiation therapy can be very helpful to shrink an
enlarged spleen or swollen lymph nodes and relieve symptoms.
Side effects from radiation therapy may include fatigue, mild skin reactions, upset
stomach, and loose bowel movements. Most side effects go away soon after
treatment is finished.
Surgery
Occasionally, surgery to remove the spleen, called a splenectomy may be
recommended because the spleen can become very enlarged in CLL.