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LEUKAEMIA : CHRONIC : LYMPHOCYTIC

How does Chronic Lymphocytic Leukaemia occur ?

The lymphocytes are made in the bone marrow and in the lymph glands (glands which fight infection). Lymphocytes are part of the body's defence against infection. In CLL too many are produced, both in the lymph glands and in the bone marrow. The earliest sign of CLL is an increased number of lymphocytes in the blood. This is often found on a routine blood test. The disease may never progress further. If it does, the next stage is usually enlargement of the lymph glands. These can be felt as lumps in the neck, the armpits, or the groins. The spleen may then become enlarged and may be felt as a lump of the left side of the abdomen. Finally, as the number of lymphocytes in the bone marrow increases, they interfere with the production of normal blood cells and anaemia (lack of red blood cells) can develop. This may cause tiredness and shortness of breath, especially on exercise. Because the lymphocytes are abnormal, they do not protect against infection, and some people with CLL have frequent infections. Chest infections are especially common, although of course most people with chest infections do not have CLL.

Why does Chronic Lymphocytic Leukaemia occur ?

Like many other cancers, the cause of CLL is unknown.

Treatment Involved for Chronic Lymphocytic Leukaemia

In the early stages, no treatment is needed, and treatment may never become necessary. Treatment is only started if the disease is interfering with the normal function of the body, for example by causing enlarged glands or anaemia. Treatment is with chemotherapy (anti-cancer drugs). These are usually given as tablets, either daily or for a few days each month. Less often, chemotherapy may be given by injection. In either case the dose will be adjusted according to the results of blood tests. Steroid drugs (like prednisolone) are often given with chemotherapy. They help destroy the leukaemic cells. When the blood count and/or the symptoms have improved, treatment may be stopped. It will be restarted again if symptoms recur.

During Treatment for Chronic Lymphocytic Leukaemia

Oral chemotherapy does not usually cause side-effects. In fact, people begin to feel better as the disease responds to treatment. You may develop mild nausea, but this is not usually troublesome enough to need treatment. Nausea is commoner with intravenous therapy and some degree of hair loss may also occur. The hair will regrow normally when treatment is finished (diffuse alopecia). Chemotherapy will also affect the normal bone marrow cells to some extent and may cause anaemia or a drop in the number of normal white blood cells. If the normal white cells are low, an infection may occur. The doctor should be told immediately if there are any symptoms of infection, especially in the chest. Shingles is more common in people with CLL and needs early medical advice. Steroids are usually given only for short periods and so side-effects are uncommon. They may cause a gain in weight, increase in appetite, and a change in mood. Some people feel more energetic, others feel low. An increase in blood pressure or an increase in sugar in the blood can occur. These problems get better as soon as the steroids are stopped.

After Treatment for Chronic Lymphocytic Leukaemia

As described above, treatment may be stopped when the disease is stable. The doctor will keep a close watch on things by doing blood tests regularly. However, he should be told if any new symptoms develop, for example, pain or enlargement of the lymph glands. This may mean that treatment needs to be started again.

If Chronic Lymphocytic Leukaemia is Left Untreated

As described above, treatment is only needed when there is evidence that the disease is progressing. If treatment was not started at this stage, then the bone marrow would gradually fill up with abnormal lymphocytes and would not be able to produce the normal blood cells properly. The bone marrow normally produces three types of cells. Red cells carry oxygen, white cells fight infection, and platelets help blood clotting. You would therefore gradually become more anaemic, even more susceptible to infection, and could develop bruising and bleeding.

Effects on Family of Chronic Lymphocytic Leukaemia

As CLL is a slowly progressive disease and one may never need treatment, there may be no changes at all in the quality of life as a result of having CLL. Even if treatment is needed, this should not interfere too much with your family and other activities. CLL is not inherited or infectious and cannot be passed on to family or friends.