What Is Chronic Lymphocytic Leukemia (CLL)?

Chronic lymphocytic leukemia (CLL) is a type of cancer that happens when your bone marrow makes too many lymphocytes, white blood cells that help your body fight infection.

Causes and Risk Factors of Chronic Lymphocytic Leukemia

While researchers don’t know exactly what causes CLL, they’ve identified the process involved.

In CLL, a genetic mutation in a single lymphocyte causes it to grow out of control. These abnormal lymphocytes continue to grow and multiply, crowding out healthy cells and interfering with normal blood cell production.

• Age Older people are more at risk.
• Race White people are more likely to develop CLL than people of other races.
• Family History Having family members who had CLL or other blood cancers may increase your risk of developing the cancer.
• Chemical Exposure Being around certain toxins, such as herbicides and insecticides, may raise your chances of CLL. People who were exposed to Agent Orange during the Vietnam War are also at an increased risk of CLL.

Types of Chronic Lymphocytic Leukemia

There are two types of CLL. Cells from these two types look similar, but doctors can tell the difference between them by running lab tests.

Tests typically look at changes on the TP53 gene, which controls cell growth, in addition to other gene and chromosome changes.

If cells are missing part of chromosome 17 or have a mutation in the TP53 gene, CLL will progress faster. Treatment may be more difficult.

Symptoms of Chronic Lymphocytic Leukemia

• Lymph node swelling
• Easy bruising

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• Fatigue
• Fever
• Night sweats
• Weight loss
• Pain in the upper part of your abdomen because of an enlarged spleen
• Frequent infections

Diagnosing Chronic Lymphocytic Leukemia

• Blood Tests Various tests may help your doctor look at the number of lymphocytes in blood samples, their shape and appearance, the presence of some proteins on cells, and changes to cell DNA.
• Bone Marrow Biopsy Your doctor may take samples of bone marrow, the spongy tissue inside your larger bones where lymphocytes are made.
• Imaging Tests Computerized tomography (CT) scans allow your doctor to check for signs of cancer in the soft tissues of your body. Your doctor also may use a positron emission tomography (PET) scan to check for complications or signs of a more aggressive case.

Treatment for Chronic Lymphocytic Leukemia

Watchful Waiting

Targeted Therapy

• acalabrutinib (Calquence)
• ibrutinib (Imbruvica)
• idelalisib (Zydelig)
• pirtobrutinib (Jaypirca)
• venetoclax (Venclexta)
• zanubrutinib (Brukinsa)

Chemotherapy

With chemotherapy, you receive strong medication as a pill or intravenously that is designed to kill cancerous cells. Your doctor might recommend one chemotherapy drug or a combination of them.

Immunotherapy

Immunotherapy uses your body’s immune system or clones of your immune system’s proteins to target and fight cancer.

In another form of immunotherapy, proteins called monoclonal antibodies are made in a laboratory and infused into your body to react to or attach to certain proteins on cancer cells. They attract your immune cells to cancerous cells, allowing the immune cells to then kill the cancerous cells.

• rituximab (Rituxan)
• obinutuzumab (Gazyva)

Stem Cell Transplant

Radiation

Surgery

Surgery alone will not cure CLL because the condition often spreads to many organs.

Leukapheresis

In rare cases, having many CLL cells in your blood causes circulation problems. If this happens, your doctor may recommend a procedure called leukapheresis.

Complementary and Integrative Therapies for Chronic Lymphocytic Leukemia

Your doctor may recommend additional therapies to protect you from infection while you are treated for CLL.

• Yoga
• Exercise
• Massage
• Acupuncture

Complications of Chronic Lymphocytic Leukemia

• Frequent Infection You may be prone to developing infections because your blood lacks enough germ-fighting antibodies.
• Other Cancers People with CLL are at an increased risk of having other types of cancer, such as melanoma, lung cancer, and cancers of the digestive tract.
• A More Aggressive Cancer Rarely, patients develop a more aggressive form of cancer called diffuse large B-cell lymphoma, also known as Richter’s syndrome.
• Immune System Problems A small number of those with CLL develop autoimmune hemolytic anemia, in which your immune system mistakenly attacks your red blood cells or platelets.

Support for Chronic Lymphocytic Leukemia

A cancer diagnosis is scary, even if your cancer is considered slow-growing. Ask your family and friends for support, be it running errands or driving to doctor appointments.

The following communities of support can help you connect with people with CLL.

CLL Society

This organization includes about 40 CLL support groups. They meet virtually every month.

Blood Cancer United

Formerly known as the Leukemia and Lymphoma Society, this group includes regional events as well as free educational programs for people with CLL, their caregivers, and their families.

American Cancer Society

Although this organization covers all types of cancer, it has many resources for people with cancer, their caregivers, and anyone seeking more information or support. It also has a 24/7 help line at 800-227-2345.

The Takeaway

• Chronic lymphocytic leukemia (CLL) occurs when your bone marrow makes too many white blood cells, and it is the most common leukemia in adults.
• CLL typically progresses slowly, with symptoms such as swollen lymph nodes and fatigue not appearing until you are older.
• Although there is no specific known cause of CLL, risk factors include age, family history, and exposure to certain chemicals.
• Treatment may include targeted medication and chemotherapy, though your doctor may recommend a “watchful waiting” approach if your CLL has no symptoms or is in an early stage.