Chronic lymphocytic leukaemia

What is CLL?

Every year in New Zealand around 120 people are diagnosed with Chronic lymphocytic leukaemia (CLL). It is the most common form of leukaemia in New Zealand.

Chronic lymphocytic leukaemia (CLL) is a type of slow-growing leukaemia that affects developing B-lymphocytes (a type of white blood cell). Under normal conditions they produce antibodies that help protect our bodies against infection and disease. In people with CLL lymphocytes undergo a malignant (cancerous change) and become leukaemic cells.

CLL usually develops and progresses slowly over many months or years. However in some cases people may need to be treated soon after they are diagnosed.

Symptoms

Many have no symptoms when they are first diagnosed. Other people may go and see their GP as they are experiencing

  • Frequent or repeated infections
  • Tiredness and fatigue
  • Weakness
  • Shortness of breath
  • Bleeding or bruising more easily
  • Red or purple flat pinhead sized purple spots on the skin particularly on the leg
  • Enlarged lymph nodes

Causes

The cause of chronic lymphocytic leukaemia is unknown and there are no clear risk factors. In rare cases CLL may result from an inherited defect in a gene, passed down from one generation to the next.

Diagnosis

CLL is diagnosed using a blood test, taken either at the hospital or a GP’s surgery. If the sample reveals an excess of lymphocytes, which are not caused by a viral infection, this could indicate the presence of CLL. If the disease is advanced the white cells, such as granulocytes, the red cells and platelets may also be reduced.

A closer analysis of the bone marrow is often carried out to confirm diagnosis and prognosis of CLL. A sample of bone marrow is taken from the hip bone and looked at under the microscope.

In some cases a lymph-node biopsy involving a small surgical procedure is necessary performed under a general anaesthetic Chest-x rays (to detect a chest infection or other abnormalities) or CT scans (to see if your spleen or liver is enlarged) are other tests which may be carried out.

Treatment

Treatment for CLL is based on several factors including the state of the disease, whether the patients have symptoms, how quickly the disease is progressing and the age of the patient.

Many patients with CLL may not require active therapy at diagnosis and some may never require treatment being put permanently on an active monitoring programme by their specialist.

For the first twelve months a patient’s blood count is measured at intervals to determine whether or not the lymphocyte count is rising rapidly or the good cells are falling. If the lymphocyte count fails to double in the first 12 months of observation in people over 60 years old, there is evidence that life expectancy will not be reduced by the presence of CLL.

It is important for people diagnosed with CLL who are being ‘actively monitored’, (where active therapy is not required) to still seek advice on lifestyle modification, particularly the management of weight, nutrition and stress avoidance in order to help improve overall health. They should also seek early medical attention if they develop viral or other infections and know how to recognise shingles or herpes zoster, two common viral infections associated with CLL.

The development of severe fatigue, weight loss, drenching night sweats, the rapid progression of lymph gland enlargement or obstruction of an important organ by lymph gland enlargement, a fall in red cells, neutrophils or platelets may indicate the need for therapy. A rising lymphocyte count on its own does not usually mean treatment is required so long as the remainder of the full blood count remains normal. Often an infection can cause a temporary rise in lymph cells but this does not necessarily imply deterioration.

Where active therapy is required there are a number of treatments that are used:

  • Chemotherapy
  • Corticosteriod therapy
  • Immunotherapy
  • Radiotherapy
  • Stem Cell Transplant
  • Clinical Trials

For more information visit our Treatment page

Chromic Lymphocytic Leukaemia

Chronic Lymphocytic Leukaemia (CLL)

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