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Introduction to Chronic lymphocytic leukemia (CLL)

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 “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.

In CLL, too many blood stem cells develop into abnormal lymphocytes and do not become healthy white blood cells. The abnormal lymphocytes may also be called leukemic cells. The lymphocytes are not able to fight infection very well. Also, as the number of lymphocytes increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may result in infection, anemia, and easy bleeding.

Causes of CLL

Doctors do not know what causes the cell-change that leads to CLL. The reason for this increase in B cells is unknown. There is no link to radiation, cancer-causing chemicals, or viruses. CLL primarily effects adults. The average age of patients with this type of leukemia is 70. It is rarely seen in people younger than 40.

Symptoms of CLL

Symptoms usually develop gradually. Many cases of CLL are detected by routine blood tests in people who do not have any symptoms.
– Abnormal bruising (occurs late in the disease).
– Enlarged lymph nodes, liver, or spleen.
– Excessive sweating, night sweats.
– Fatigue.
– Fever.
– Infections that keep coming back (recur).
– Loss of appetite or becoming full too quickly (early satiety).
– Unintentional weight loss.

Diagnosis of CLL

The diagnosis of CLL is usually made from blood and bone marrow tests.
Blood Tests : The testing for CLL includes blood cell counts and a blood cell examination.
– Blood cell counts : A person with CLL will have a high lymphocyte count. He or she may also have a low red cell count and a low platelet count.
– Blood cell examination : The CLL cells are usually examined with an instrument called a “flow cytometer.” The test is called flow cytometry or immunophenotyping. The test is done to find out if CLL is the reason for the high lymphocyte count. Flow cytometry also shows if the CLL is B-cell CLL or T-Cell CLL. B-cell CLL is most common.
– Immunoglobulin Test : Doctors check the immunoglobulin level in the blood. Immunoglobulins are proteins that help the body fight infection. People with CLL may have low levels of immunoglobulins. A low immunoglobulin level may be the cause of repeated infections.

Bone Marrow Tests and Cytogenetic Tests
Bone marrow tests are not usually needed to make a CLL diagnosis. But it’s often helpful to have a bone marrow aspiration and a bone marrow biopsy before treatment begins. The results of these tests serve as a baseline that is used later on to assess the effects of treatment.
– FISH or fluorescence in situ hybridization is a test used to see if there are changes to the chromosomes of the CLL cells.

Goals of CLL Therapy

It is important to get treatment in a center where doctors are experienced in the care of patients with CLL. The goals of CLL treatment are to :
– Slow the growth of CLL cells.
– Provide long periods of remission (when there are no signs of CLL and/or people feel well enough to carry on their day-to-day activities).
– Help people to feel better if they have infections, fatigue or other symptoms.

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