Chronic Lymphocytic Lukemia

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Chronic Lymphocytic Lukemia 

Chronic lymphocytic leukemia (also called CLL) is a blood and bone marrow disease that usually gets worse slowly.  

Like all leukemias, chronic lymphocytic leukemia is a cancer of the blood cells. Chronic lymphocytic leukemia (CLL) affects a certain type of white blood cell, called a B lymphocyte. This disease is also called B-cell chronic lymphocytic leukemia. 

B cells originate in the bone marrow, mature in the lymph nodes, and then circulate in the blood to help fight infections. Chronic lymphocytic leukemia (CLL) is the second most common type of leukemia in adults.

Causes

  • Radiation treatments used in the past to treat thyroid cancer or Hodgkin’s lymphoma
  • Nuclear disaster

Symptoms

  • Enlarged, but painless, lymph nodes
  • Fatigue
  • Fever
  • Pain in the upper left portion of the abdomen, which may be caused by an enlarged spleen
  • Night sweats
  • Weight loss
  • Frequent infections


Treatments


Bone marrow or cord blood transplant

The type of bone marrow or cord blood transplant that is most often used to treat Chronic lymphocytic leukemia (CLL) is called an allogeneic transplant. An allogeneic transplant replaces the abnormal cells in the patient’s bone marrow with healthy blood-forming cells from a family member, unrelated donor or cord blood unit. The first step in an allogeneic transplant is finding a matching donor – someone who can donate marrow or peripheral blood – or a cord blood unit to provide these blood-forming cells.

Reduced-intensity and non-myeloablative transplants

For some people with chronic lymphocytic leukemia or CLL, an allogeneic transplant may offer the best chance for a long-term remission. In a standard transplant, patients get very high doses of chemotherapy and/or radiation before the transplant. This is called the pre-transplant conditioning regimen. A high-dose conditioning regimen has two goals:
  • To wipe out as many cancerous cells in the patient’s marrow and bloodstream.
  • To prevent rejection of the donated cells by the patient's immune system. But such high doses can also damage organs such as the liver, kidneys and heart.

The median age of patients with CLL is 72 years; many patients would not tolerate a standard transplant. For an older patient with CLL, a transplant doctor may suggest a transplant that uses lower doses of chemotherapy and may not use radiation at all. This type of transplant is called a reduced-intensity or non-myeloablative transplant. These less intense conditioning regimens have been in use for more than 10 years and results are equal to and sometimes better than transplants using standard conditioning regimens.

Autologous transplants for CLL

Autologous transplantation is not as common as allogenic transplantation in treating Chronic lymphocytic leukemia (CLL). In an autologous transplant, a patient receives his or her own blood-forming cells. These cells are collected from the patient’s blood or marrow, preferably when he or she is in remission, and then frozen and stored. The patient then receives a very high-dose conditioning regimen, after which the thawed cells are given back to the patient intravenously. Autologous transplant recipients have been shown to experience remissions of 5-6 years, so it remains a possible treatment option for some patients with CLL.

Chemotherapy

During chemotherapy, you'll be given potent drugs that must be toxic enough to damage or kill leukemic cells. At the same time, they take aim at normal cells and can cause side effects. Yet, not everyone experiences side effects and people react differently. Doctors commonly combine two or more chemotherapy drugs to treat CLL. Each drug type works in a different way to kill the cancerous cells. Combining drug types can strengthen their effectiveness.

Monoclonal Antibody Therapy

Drug therapy using monoclonal antibodies can be an effective treatment. A monoclonal antibody is an immune protein made in a laboratory. It's designed to target a specific molecule on the surface of CLL cells. The monoclonal antibody aims for the molecule and attaches itself to the cell, causing the cell to die. Monoclonal antibody therapies can cause side effects, but they're generally milder than chemotherapy's side effects. Because they're designed to target and attack specific substances, they tend to leave normal cells unharmed.

Radiation Therapy

Though not used often to treat chronic lymphocytic leukemia (CLL), radiation therapy is sometimes used to relieve pain caused by an enlarged lymph node, spleen or other organ. The enlarged masses can affect the functions of nearby organs, such as the kidneys, gastrointestinal tract or throat. Also called radiotherapy, this painless treatment uses X-rays or other high-energy rays to kill cancer cells. This reduces the size of swollen lymph nodes and organs.
1. Dr. Dharma Chaudhary, Sr. Consultant & Director, Centre for Bone Marrow Transplant, BLK Super Speciality Hospital, Pusa Road, New Delhi - 110005, India.
He is an expert in Bone Marrow Transplant and having a rich experience in this field.



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