What Is Chronic Lymphocytic Leukemia (CLL)? Symptoms, Stages, and Treatment

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

This leukemia is usually very slow-growing, but there’s also a form of CLL that progresses more quickly.

There are several effective treatment options for CLL, but sometimes a “watch-and-wait” approach is recommended. (1)

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Who Gets Chronic Lymphocytic Leukemia?

According to the American Cancer Society, there are nearly 21,000 new cases of CLL each year in the United States, and a little more than 4,500 people die from the disease annually.

CLL accounts for about one-quarter of all new cases of leukemia.

This type of cancer mainly affects older adults and is rarely diagnosed in children. The average age at diagnosis is about 70 years old. (2)

How Does This Type of Leukemia Happen?

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.

Scientists are working to find out precisely what triggers the disease process. (3)

The Different Types of Chronic Lymphocytic Leukemia

Everyone’s CLL grows at a different pace, ranging from very slow (indolent) to very fast.

The fast-growing CLL is considered a more serious disease.

Cells from these two types look similar, but doctors can tell the difference between them by running lab tests. If, on these tests, the CLL cells have low levels of the proteins ZAP-70 and CD38, the cancer tends to be of the more slow-growing variety, though there are always exceptions to this rule. (4)

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Symptoms of Chronic Lymphocytic Leukemia

Many people with CLL don’t have symptoms for years. If you do experience symptoms, you might have:

  • Enlarged lymph nodes
  • Fatigue
  • Fever
  • Night sweats
  • Weight loss
  • Pain in the upper part of your abdomen (due to an enlarged spleen)
  • Frequent infections (3)

What Are the Risk Factors for Chronic Lymphocytic Leukemia?

Risk factors that may increase your chances of developing CLL include:

  • Age Older people are more at risk.
  • Race Caucasians have a higher likelihood of developing CLL compared with people of other races.
  • Family History Having family members who had CLL or other blood cancers may up your risk of having the cancer, too.
  • Exposure to Chemicals Being around certain toxins, such as herbicides and insecticides, may raise your chances of having CLL. People who were exposed to Agent Orange during the Vietnam War are also at an increased risk for CLL. (3)

Diagnosing Chronic Lymphocytic Leukemia 

Your doctor may diagnose CLL or determine the extent of your disease by taking a medical history and performing a physical exam, as well as by performing certain tests, including:

  • Blood Tests Different lab tests are done, so your doctor can check your blood cell count and learn more about the lymphocytes involved in your cancer.
  • Bone Marrow Biopsy This is a procedure in which samples of bone marrow, a spongy tissue inside your larger bones where lymphocytes are made, are taken via a needle.
  • Imaging Tests Computerized tomography (CT) or positron emission tomography (PET) scans allow your doctor to check for signs of cancer in the soft tissues of the body. (3)

How to Treat Chronic Lymphocytic Leukemia

Your treatment will depend on how advanced your disease is, the type of CLL you have, and whether your cancer has come back.

Options may include chemotherapy, targeted therapies that are designed to silence specific proteins, radiation, certain procedures, or no treatment at all. Sometimes several treatments are used together.

Chemotherapy With chemotherapy, drugs are used to kill cancer cells. It can be given intravenously (IV) or taken as a pill. Your doctor might recommend one chemotherapy drug or a combination of them. (3)

Targeted Therapy Targeted therapies home in on different changes inside cells that cause them to become cancerous. These medicines typically cause less severe side effects than chemo. Examples include:

  • acalabrutinib (Calquence)
  • ibrutinib (Imbruvica)
  • idelalisib (Zydelig)
  • venetoclax (Venclexta) (5)

Monoclonal Antibodies Monoclonal antibodies are proteins made in the lab that react to or attach to certain proteins on cancer cells. These are a form of immunotherapy, in that they act — in part — by attracting your immune cells to the cancerous cells, allowing the immune cells to then kill the cancerous cells. Some monoclonal antibodies used to treat CLL are:

  • rituximab (Rituxan)
  • obinutuzumab (Gazyva) (5)

Immunotherapy Immunotherapy uses your body’s immune system to target and fight cancer. A novel treatment known as CAR T-cell therapy involves removing specific immune cells from the blood and enhancing them in the lab to make them more active against the patient’s cancer. Then the cells are infused back into the patient’s body, so they can find and destroy leukemia cells. This therapy has shown promise for other types of leukemia but is still considered experimental for CLL.

Researchers are also studying whether certain vaccines made from a patient’s CLL cells and a protein that stimulates the immune system can help fight CLL. (6)

Stem Cell Transplant A stem cell transplant usually isn’t needed for CLL, but it can be an option. The procedure involves delivering high doses of chemotherapy and sometimes radiation in order to eradicate a patient’s diseased bone marrow. After that has been accomplished, patients receive a transplant of blood-forming stem cells to restore their bone marrow. (7)

Radiation Radiation uses X-rays or other types of energy to destroy cancer cells. This treatment isn’t common for people with CLL, but some benefit from it. (8)

Surgery Occasionally, a surgery to remove your spleen, known as a splenectomy, is performed if you have CLL. A splenectomy won’t cure the cancer, but it may help improve your symptoms. (9)

Leukapheresis Sometimes high numbers of CLL cells in your blood cause circulation problems. If this happens, a procedure called leukapheresis, in which blood is removed from the body and processed through a machine that removes white blood cells and leukemia cells, may be recommended to help lower white blood cell counts. (10)

Watchful Waiting If the CLL is very slow-growing or in its early stages, a doctor might recommend watching the disease until it progresses. Doctors call this “watchful waiting.” Research has shown that early treatment doesn’t prolong survival for people with early-stage CLL. (3)

What Alternative Therapies Can Help?

While alternative therapies won’t cure your cancer, they may help you feel better and cope with certain side effects. Some common approaches to help patients with CLL are:

  • Meditation
  • Yoga
  • Exercise
  • Massage
  • Relaxation techniques

Green tea extract is another alternative treatment that has shown some promise for treating CLL in clinical studies. Scientists have found that a compound in green tea extract, called EGCG, may kill CLL cells. A study in humans with early-stage CLL showed an EGCG pill reduced some signs of the cancer. Doctors say that while this is exciting, more research needs to be done on this potential therapy. (3)

What Health Complications May Co-Occur With Chronic Lymphocytic Leukemia?

Chronic Lymphocytic Leukemia (CLL) can cause additional health complications, such as:

  • Frequent Infections You may be prone to developing infections if you have CLL.
  • 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, which is also known as Richter’s syndrome.
  • Immune System Problems A small number of those with CLL develop a problem that causes their immune system to mistakenly attack red blood cells or platelets in the body. (3)

How Can You Cope With Your Diagnosis?

While this cancer is often considered slow-growing, receiving any type of cancer diagnosis can be scary. Here are some ways to cope:

  • Learn About Your Disease Look for reliable information about your cancer, so you can make informed decisions. Some good resources are the American Cancer Society, the National Cancer Institute, and the Leukemia & Lymphoma Society.
  • Connect With Others Joining an online or in-person support group can help you connect with people who have your same type of cancer.
  • Ask for Help Don’t be afraid to accept assistance from your friends or family members. You might need someone to drive you to your doctor’s appointments or run other errands. (3)

What Is the Outlook for Chronic Lymphocytic Leukemia?

Generally, CLL is a slow-growing cancer with a favorable prognosis, but this depends on the stage of your disease.

The five-year survival rate for people with CLL is 83 percent. (11)

It’s important to know that survival rates are only estimates, and each case of CLL is different.

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