Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia (CLL) is a type of leukemia that starts in the lymphoid cells in the bone marrow. These are cells that normally help the body fight infection. As the leukemia cells grow, they can crowd out the normal cells in the bone marrow. This can lead to not enough different types of blood cells. People with CLL have too many lymphocytes in their blood, but these cells are not normal and don't help fight infection. In fact, people with CLL are more likely to get an infection. 

CLL is a type of chronic leukemia. This means it tends to grow slowly. Many people with CLL do not have any symptoms when it’s first found. This kind of leukemia often doesn’t need to be treated right away. But some cases of CLL grow faster than others. Healthcare providers look at the cells in a lab to see what kind of CLL a person has.

Many people don’t have any symptoms before being diagnosed with CLL. The cancer is often found when a person has blood tests done for another reason and the tests show too many white blood cells. If CLL does cause symptoms, they can include: 

• Feeling tired (fatigue).

• Feeling weak.

• Fevers, chills, or night sweats.

• Frequent infections.

• Enlarged lymph nodes, often felt as lumps beneath the skin.

• Pain or a sense of fullness in the upper abdomen, from an enlarged spleen.

• Weight loss.

• Bleeding or bruising easily.

Many of these symptoms may be caused by other health problems, but it is important to see your healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have CLL or another type of cancer.

If your healthcare provider thinks you might have CLL, you will need certain exams and tests to be sure. Your healthcare provider will ask you about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam.

You may have one or more of the following tests:

• Blood tests. CLL is often found with blood tests before a person has symptoms. Tests can look at the numbers of different types of blood cells. People with CLL often have too many lymphocytes. This is a type of white blood cell.

• Bone marrow aspiration and/or biopsy. This procedure is done by taking a small amount of bone marrow fluid (aspiration) and/or solid bone marrow tissue (core biopsy). The sample is often taken from the back of the hip (pelvic) bone. For the bone marrow aspiration, the area over the hip is numbed. A thin, hollow needle is put into the pelvic bone. A syringe is used to pull out a small amount of liquid bone marrow. You may have some brief pain when the marrow is removed. A bone marrow biopsy is usually done just after the aspiration. A slightly bigger needle is used to take out a small core of bone and marrow. The biopsy may also cause some brief pain. The fluid and bone marrow are examined for the number, size, and maturity of the blood cells and for abnormal cells. Other tests can also be done on these cells but they are not usually needed to diagnose CLL.

Tests can be done on blood (or less often, bone marrow) samples to diagnose CLL and help determine how quickly it is likely to grow. The tests include:

• Flow cytometry and immunohistochemistry. These tests use chemicals and dyes to look for certain substances on the surface of the leukemia cells. This is called immunophenotyping. These tests are used to diagnose CLL.

• Cytogenetics. These tests look for changes in the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. For example, in CLL, part of a chromosome may be missing or there may be extra copies of a chromosome. This test usually takes a few weeks because the cells need time to be grown in the lab.

• Fluorescent in situ hybridization (FISH). This test uses special fluorescent dyes that only attach to certain parts of chromosomes. It can be used to look for certain changes in genes and chromosomes that are found in CLL cells from blood or bone marrow samples. The FISH test is very accurate and gives results more quickly than standard cytogenetic tests.

When the results of your tests are in, your healthcare provider will contact you to discuss them. He or she will also talk with you about other tests you may need if CLL is found. Make sure you understand the results of your tests and what follow-up you need.