Chronic lymphocytic leukaemia (CLL) is cancer of a specific type of white blood cells, called B-lymphocytes, which accumulate in the blood, bone marrow and lymph nodes. CLL is more common in older people and affects men more than women. During the early stages of the disease, it can be present without any symptoms and is often diagnosed after a routine blood test undertaken for something else.
CLL has a variable natural history with some patients remaining well and not requiring treatment for many years, while for others it can progress more quickly and need treatment soon after diagnosis. Treatments for CLL have made rapid advances over the last 10 years and patients have a number of effective options. We will be happy to discuss these with you in clinic to maximise the effectiveness of therapy and maintain a good quality of life.
In its early stages, CLL may not cause any noticeable symptoms. As the condition develops, symptoms can include:
- repeated infections that occur over a short period of time and may require repeated courses of antibiotics
- tiredness or breathlessness which may be due to a lack of red blood cells (anaemia)
- unusual bleeding and bruising
- unexplained fevers
- drenching night sweats
- unintentional weight loss
- swollen spleen which may manifest itself in feeling full after only eating small amounts, or discomfort or pain in the abdomen
- swollen lymph nodes (glands), especially around the neck or collar bone, armpits or groin
Bone marrow – the spongy material found inside bones – contains a specialised type of cell called stem cells. These stem cells can develop into any of the three types of blood cell:
- red blood cells – which carry oxygen around the body
- white blood cells – which help fight infection and come in various forms
- platelets – which help stop bleeding.
In CLL, the body starts producing lots of white blood cells that aren't fully developed; specifically B-lymphocytes, which enter the blood stream and caused an increased white cell count on routine blood tests.
Over time, the overproduction of CLL cells is at the expense of the other blood cells, and this results in reduced numbers of red blood cells (anaemia) and platelets (thrombocytopenia) that can cause symptoms of tiredness, lethargy and shortage of breath as well as increasing the likelihood of bruising or bleeding due to low platelets.
The lymphocytes not only live in the bone marrow but can also live and grow within the lymphatic system and patients often have lymphadenopathy (a swelling of lymph nodes), with or without an enlarged liver and spleen.
CLL is the most common type of leukaemia in adults. In most cases, the exact cause of CLL is unknown. However, there are a few known risk factors, which may increase the chance of developing CLL, including:
- having a family history of the condition
- being of European, American or Australian origin (it is rare in people from China, Japan and South East Asia)
- being male
- being older.
In addition to low blood counts and enlarged lymph nodes, one of the main complications of CLL is increased vulnerability to infection. This is because your immune system will be weakened due to a reduced number of healthy, infection-fighting white blood cells and lower levels of antibodies.
Due to the risk of infection, we advise patients to maintain up-to-date vaccinations. Evidence shows that some patients respond particularly well if they are vaccinated early in the disease. The CLL team will provide you and your GP with the latest information and guidance.
Other complications include autoimmune anaemia or thrombocytopaenia; these are caused by the immune system breaking down red cells and platelets, respectively.
CLL can also transform into a faster growing disease, a Hodgkin’s or non-Hodgkin’s lymphoma called Richter’s transformation. This occurs in approximately 2% to 10% of CLL patients during the course of their disease. If this happens, we will explain the change in greater detail and discuss treatment options.