Chronic lymphocytic leukemia is a generalized, progressive disease marked by an uncontrollable spread of abnormal, small lymphocytes in lymphoid tissue, blood, and bone marrow. When these cells infiltrate bone marrow, lymphoid tissue, and organ systems, clinical signs begin to appear.

This disease occurs most commonly in elderly people; nearly all those afflicted are men over age 50. According to the American Cancer Society, chronic lymphocytic leukemia accounts for almost one-third of new leukemia cases annually.

Chronic lymphocytic leukemia is the most benign and the most slowly progressive form of leukemia. However, the prognosis is poor if anemia, thrombocytopenia, neutropenia, bulky lymphadenopathy, and severe lymphocytosis develop. Gross bone marrow replacement by abnormal lymphocytes is the most common cause of death, usually within 4 to 5 years of diagnosis.

Causes of Chronic Lymphocytic Leukemia

Although the cause of the disease is unknown, researchers suspect hereditary factors because a higher incidence has been recorded within families. Undefined chromosomal abnormalities and certain immunologic defects, such as ataxia telangiectasia or acquired agammaglobulinemia, are also suspected. The disease doesn't seem to result from radiation exposure.

Signs & Symptoms of Chronic Lymphocytic Leukemia

Abnormal bruising (occurs late in the disease)
Enlarged lymph nodes, liver, or spleen
Excessive sweating, night sweats
Fatigue
Loss of appetite
Unintentional weight loss

Diagnostic Tests

Typically, chronic lymphocytic leukemia is an incidental finding during a routine blood test that reveals numerous abnormal lymphocytes. In the early stages, the patient has a mildly but persistently elevated white blood cell (WBC) count. Granulocytopenia is the rule, although the WBC count climbs as the disease progresses.

Blood studies also reveal a hemoglobin count under 11g/dl, hypogammaglobulinemia, and depressed serum globulin levels. Other common developments include neutropenia (less than I ,500/mm3), lymphocytosis (more than IO,OOO/mm3), and thrombocytopenia, (less than 150,OOO/mm3).

Bone marrow aspiration and biopsy show lymphocytic invasion. A computed tomography scan identifies affected organs.

Treatment

Systemic chemotherapy includes alkylating agents, usually chlorambucil or cyclophosphamide, and sometimes corticosteroids (prednisone) when autoimmune hemolytic anemia or thrombocytopenia occurs.

When chronic lymphocytic leukemia causes obstruction or organ impairment or enlargement, local radiation therapy can reduce organ size, and splenectomy can help relieve the symptoms. Allopurinol can prevent hyperuricemia, a relatively uncommon finding.

Radiation therapy can help relieve symptoms. It's generally used to treat enlarged lymph nodes, painful bony lesions, or massive splenomegaly.

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