Leukemia is the cancer of the white blood cells of the bone marrow (spongy part of long bones). Patients with leukemia have an overproduction of a type of blood white cell in the body. In chronic lymphocytic leukemia (CLL), the bone marrow produces too many immature lymphocytes (a type of white cells). These lymphocytes are not trained to fight infections in the body. These cells rather grow into the marrow and hamper the normal functioning of marrow. Over time this results in:
- Increased risk of infections
- Persistent tiredness
- Swollen glands in the neck, armpits, or groin
- Unusual bleeding or bruising
CLL progresses slowly whereas acute lymphocytic leukemia (ALL) progresses quickly. CLL is the most common type of leukemia in adults. It mostly affects people older than 60 years; it is rarely found in people younger than 40 years and extremely rare in children. CLL has a relatively higher survival rate than many other cancers. The 5-year survival rate for CLL is around 83%. For people older than 75 years, the 5-year survival is less than 70%.
CLL itself is not listed as a disability. There are no symptoms in the initial stages of CLL, and it is often discovered during routine blood investigations. However, as the disease progresses, patients can develop symptoms that can disable the patient and affect the quality of life. At this stage, it may be possible to apply for social security disability benefits. The process with CLL can be difficult because it involves proving disabilities involving several body functions.
Some of the criteria include:
- A lymphocyte count above 10,000 per mm3 of blood consistently over 3 months.
- Chronic anemia, which requires blood transfusion at least every other month or has a significant effect on other body systems.
- Neutrophil counts should be under 1,000 cells per m3 in multiple blood tests.
- The patient must suffer at least three bacterial infections in the past 5 months.
It is advised to consult a doctor and social security disability attorney who will be able to provide the required information.
What are the signs and symptoms of chronic lymphocytic leukemia?
There may be no symptoms initially. The following signs and symptoms may be present as the disease progresses:
- Painless swollen lymph nodes in the neck, groin, or armpits due to lymphocyte accumulation
- Abdominal fullness, swelling, and pain due to enlarged spleen
- Anemia and pale skin due to reduced red blood cells
- Bleeding and bruising occur more easily due to extremely low platelet count
- Petechiae (flat, dark-red spots under the skin caused by intradermal bleeding)
- Shortness of breath
- Loss of appetite
- Unintentional or unexplained weight loss
- Recurrent infections
- Drenching night sweats
Stages of chronic lymphocytic leukemia
Progression of CLL is staged based on the enlargement of lymph nodes and other organs and the effect on red blood cells and platelets.
Commonly, CLL is staged using the Rai staging system that defines 5 stages from 0 to 4. All stages of CLL have lymphocytosis or a high lymphocyte count.
- Stage-0: There are no symptoms and has more than 5,000 lymphocytes per microliter of blood.
- Stage-1: The patient has lymphocytosis and enlarged lymph nodes.
- Stage-2: The patient has lymphocytosis, swollen lymph nodes, and enlarged liver and/or spleen.
- Stage-3: The patient is anemic has lymphocytosis, swollen lymph nodes, and enlarged liver and/or spleen.
- Stage-4: The patient has low platelet count, lymphocytosis, anemia, swollen lymph nodes, and enlarged liver and/or spleen.
Stage-0 is considered an early stage or low-risk stage. Stage-1 and stage-2 are considered intermediate stages. Stage-3 and stage-4 are considered advanced stages where CLL progresses rapidly.
How is chronic lymphocytic leukemia treated?
CLL is slow-growing leukemia that progresses slowly over many years. The early stages of CLL do not present any symptoms and do not require immediate treatment. The disease may be monitored regularly and treatment is started when CLL progresses. CLL cannot be cured completely, and treatment can help control the condition for many years.
Treatment options for patients who have intermediate or advanced stages of CLL include:
- Chemotherapy: Cancer cells are destroyed using a combination of two or more drugs.
- Targeted cancer drugs: Drugs that identify and attack specific cancer cells are used. Tyrosine kinase inhibitor (TKI) therapy, BCL2 inhibitor therapy, and monoclonal antibody therapy are types of targeted therapies used to treat CLL.
- Immunotherapy: Uses special medications to activate the patient’s immune system to recognize and destroy cancer cells. Immuno-modulating agent lenalidomide and CAR T-cell therapy are used to treat CLL.
- Radiotherapy: High-energy waves are used to destroy cancer cells, shrink swollen lymph nodes, or spleen.
- Stem cell or bone marrow transplants: After destroying the patient’s stem cells using strong chemotherapy medications, healthy stem cells from a donor are transplanted into the patient. The transplanted stem cells start producing healthy blood cells in the patient’s body.
- Leukapheresis: Blood is passed through a special machine to lower the high number of CLL cells by filtering them out. This treatment is used as a temporary fix. Chemotherapy or immunotherapy is required to destroy the cancer cells.
- Surgery: If chemotherapy or radiation does not shrink an enlarged spleen, surgery may be performed to remove it.
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Chisti MM. Chronic Lymphocytic Leukemia (CLL). Medscape. https://emedicine.medscape.com/article/199313-overview
Aplastic Anemia and MDS International Foundation. Chronic Lymphocytic Leukemia (CLL). https://www.aamds.org/diseases/related/chronic-lymphocytic-leukemia-cll
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