Chronic lymphocytic leukemia (CLL) has a highly variable natural history. The survival rate varies with the stage at the time of diagnosis, existing comorbidities, age, and tolerance to cancer treatment.
With promising research in the field of oncology, the survival rate in people with CLL has shown an upward trend. According to recent statistics, the five-year survival rate of people who are 20 years and older with CLL is 86 percent. Over and above, mortality from the disease dropped to about three percent annually between 2008 and 2017.
- For most people, the goal of treatment is to keep CLL under control for as long as possible.
- Some people may never require treatment (approximately 10 percent of people), whereas others may alternate between periods of treatment and remission (watch and wait or active monitoring).
- Because there are many effective treatment options for CLL, it can be managed for many years.
- CLL typically grows very slowly, and people may have to wait many years between treatments. Some people, however, have a faster-growing form that will require more frequent treatment.
- Certain cell mutations can make CLL more difficult to treat and increase the risk of death.
- People with CLL at a lower stage (with less disease) generally have a better prognosis than those with more advanced CLL.
- Most people live for about 10 years, but this varies depending on how CLL behaves.
- People in stages 0 to II may live for 5 to 20 years without treatment.
- CLL has a very high incidence rate in people older than 60 years.
- CLL affects men more than women. If the disease has affected the B cells, the person’s life expectancy can range from 10 to 20 years. People with T cell CLL have a very short life expectancy.
It is best to speak with your doctor about your specific situation because each person diagnosed with CLL has a unique journey. Because of this, survival statistics that you may read about can be difficult to interpret.
What is CLL?
Lymphocytes are classified into two types:
- B lymphocytes, and
- T lymphocytes.
These white blood cells are important components of the immune system because they aid in the fight against infection.
B cells are affected in more than 90 percent of CLL cases. These abnormal B cells have no function; these are parasites that compete with the normal blood cells for nutrition and oxygen. Consequently, the healthy red blood cells, white blood cells, and platelets die.
Many people have no initial symptoms of CLL because it develops slowly.
8 symptoms of CLL
Possible symptoms of CLL include:
- An enlarged spleen that causes pain or discomfort under the ribs on the left side
- Fever of unknown or unexplained origin
- Anemia (a condition caused by lack of red blood cells) that causes fatigue, dizziness, pallor, and shortness of breath when physically active
- Increased or unexplained bleeding or bruising and/or the appearance of red or flat pinhead-sized purple spots on the skin, particularly on the legs at first, that are caused by a very low platelet count
- Infections that occur frequently or repeatedly, as well as slow healing, are caused by a lack of normal white blood cells
- Painless swelling of the lymph nodes (glands) in the neck, under your arms, or in the groin is usually caused by lymphocytes accumulating in these tissues
- Excessive night sweating
- Unintentional weight loss
2 types of CLL
Chronic lymphocytic leukemia (CLL) can be slow-growing (indolent) or fast-growing (rapid) (aggressive).
- Indolent CLL:
- Slow-growing CLL can remain stable for years without treatment.
- If your CLL is indolent, it means that there are abnormal lymphocytes in your blood, but your other blood cell counts are normal or slightly below normal.
- People with CLL who are in the early stages of the disease may become aware of their illness when their primary care physician orders routine tests or diagnostic tests for other symptoms.
- However, if you have slow-growing CLL, you may not experience any symptoms.
- Aggressive CLL:
- Aggressive CLL grows quickly and necessitates more immediate treatment.
- If your CLL is aggressive, it means there are too many lymphocytes and abnormal cells in your blood, leaving little to no room for other healthy blood cells.
- If the disease is not treated, it can lead to serious complications.
2 staging systems of CLL
Staging is important because it assists your medical team to determine the best course of treatment for you. Because chronic lymphocytic leukemia (CLL) generally affects your blood rather than your lymph nodes, it is staged differently.
CLL can be staged in the following two ways:
- Binet system:
- Stage A: You have no more than three areas of lymphoid swelling (a swollen liver or spleen or swollen lymph nodes in your neck, armpits, or groin).
- Stage B: You have three or more lymphoid swelling areas.
- Stage C: You have thrombocytopenia (a low platelet count) and/or anemia (a low red blood cell count).
- Rai system:
- Stage 0: Your lymphocyte count is extremely high.
- Stage I: You have an elevated lymphocyte count and swollen lymph nodes.
- Stage II: You have a high lymphocyte count, a swollen liver or spleen, and swollen lymph nodes.
- Stage III: You have an elevated lymphocyte count and anemia (a low red blood cell count), with or without swollen lymph nodes, liver, or spleen.
- Stage IV: You have an elevated lymphocyte count and thrombocytopenia (a low platelet count), with or without swollen lymph nodes, a swollen liver or spleen, or anemia.
Many people with CLL have no obvious symptoms.
During routine blood tests and/or a physical examination, doctors may detect the disease. Others detect the disease when symptoms appear and the person visits the doctor because they are worried, uncomfortable, or do not feel well.
CLL can cause various symptoms depending on where the tumor is in the body.
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5 treatment options for CLL
There are several treatment options for chronic lymphocytic leukemia (CLL) that are effective.
Although most current treatments do not cure CLL, they do help with its management. Some people with CLL can go years without treatment, whereas the majority of people will require treatment on and off for years.
The following five types of standard treatment are used:
- Waiting with vigilance: This is also known as observation. During this time, doctors address the disease's complications, such as infection.
- Radiation therapy: This treatment uses high-energy X-rays or other types of radiation to either kill or prevent cancer cells from growing.
- Chemotherapy: It is the use of drugs to halt the growth of cancer cells, either by killing them or preventing them from dividing.
- Surgery: Doctors usually recommend splenectomy, which is the surgical removal of the spleen.
- Targeted therapy: It involves the use of drugs or other substances to identify and attack specific cancer cells while causing no harm to normal cells.
New types of treatment are being tested in clinical trials, such as:
- Chemotherapy with stem cell transplant:
- This is a method of administering chemotherapy while replacing blood-forming cells that have been destroyed by cancer treatment.
- Stem cells (immature blood cells) are extracted from the person’s or donor’s blood or bone marrow and stored in frozen form.
- After chemotherapy sessions are completed, the stored stem cells are thawed and infused back into the person. These reinfused stem cells develop into (and restore) blood cells in the body.
- A cancer treatment that uses the person’s immune system to combat the disease.
- Substances produced by the body or created in a laboratory are used to augment, direct, or restore the body’s natural anti-cancer defenses.
- This cancer treatment is also known as biotherapy or biologic therapy.
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Key Statistics for Chronic Lymphocytic Leukemia: https://www.cancer.org/cancer/chronic-lymphocytic-leukemia/about/key-statistics.html
Leukemia - Chronic Lymphocytic - CLL: Statistics: https://www.cancer.net/cancer-types/leukemia-chronic-lymphocytic-cll/statistics
CLL Stages and Treatments: https://www.webmd.com/cancer/lymphoma/cll-explained-19/slideshow-cll-stages-treatment
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