Chronic Lymphocytic Leukaemia (CLL) Treatment

Chronic lymphocytic leukaemia is a type of leukaemia (cancer of the blood and bone marrow) that most commonly affects people over the age of 65. It is a cancer that affects lymphocytes, a type of white blood cells, and progresses at a slower pace. The condition causes lymphocytes to mutate and become cancerous, multiplying and crowding out healthy blood cells.

The primary cause of CLL is DNA mutations in lymphocytes. However, what starts this process is not known, and the research is still ongoing. 

Certain factors can increase the chances of developing CLL, which include:

• Age: CLL is mostly diagnosed in older people.
• Family history: A family history of blood or bone marrow cancer can increase the risk.
• Exposure to certain chemicals: Exposure to chemicals like herbicides and insecticides can increase the chances of developing CLL.

Chronic lymphocytic leukaemia doesn’t present with any symptoms initially. Symptoms might start appearing, once the disease progresses to more advanced stages. Some of these include:

• Fatigue
• Fever
• Swollen lymph nodes
• Weight loss
• Night sweats
• Frequent infections
• Prolonged bleeding and easy bruising
• Pain under the ribs

Following a medical history review and asking about the symptoms, the doctor will order the following tests for the confirmation of CLL:

• CBC Test:  A complete blood count (CBC) can help identify the number of red blood cells, white blood cells, and platelets in the blood. An abnormal cell count may indicate CLL.
• Peripheral blood smear: A blood smear can help identify cancerous cells by looking at them under a microscope.
• Flow cytometry: Flow cytometry is a blood test that can determine the cause of an elevated lymphocyte count, whether due to CLL, another blood disorder, or an infection.
• Genetics Test: A genetics test like fluorescent in situ hybridization (FISH) is done to analyse the mutated chromosomes and genes. This can help determine the right treatment option.

Doctors use two methods of staging for CLL: Rai and Binet.

Rai Staging System

The Rai staging system categorises CLL based on the risk of disease progression. 

• Low risk: Low risk stage is defined as the stage where the person has lymphocytosis and abnormal white blood cells in the blood/bone marrow.
• Intermediate risk: At the second or intermediate stage, lymphocytosis is accompanied by swollen lymph nodes and an enlarged spleen or liver.
• High risk: Characterised by anaemia or thrombocytopenia, indicating and advanced stage of CLL.

Binet Staging System

The Binet staging system categorises the stages of CLL on the basis of blood cell and platelet count and number of areas with swollen lymph nodes.

• Stage A: Stage A is characterised by normal platelet and blood cell levels but with swollen lymph nodes in fewer than three areas of the body.
• Stage B: In stage B, three areas of the body have swollen lymph nodes and the blood cells and platelet count is normal.
• Stage C: Stage C is defined by low red blood cell count (anaemia) and swollen lymph nodes in at least three or more areas of the body.

Watchful Waiting

Chronic lymphocytic leukaemia might not require immediate treatment if it is asymptomatic and not progressing. In such cases, the doctor will carefully monitor the condition through a routine of planned blood tests and check-ups. This approach helps avoid the side effects and complications of treatment, until treatment becomes necessary.

Targeted Therapy

Targeted therapy works by targeting the cancer cells directly. The goal is to destroy cancer cells without harming healthy cells. This can be done through various medications that work by targeting the enzyme.

Chemotherapy

Chemotherapy is done as an initial treatment. It works to kill cancer cells or slow their growth. Chemotherapy is either administered orally or intravenously. 

Immunotherapy

Immunotherapy helps in increasing or boosting the body’s ability to fight off cancer cells. It is done for severe cases of CLL or when there is no improvement with chemotherapy.

Bone Marrow Transplant

In certain situations, the only option left is a bone marrow transplant. In the process, the patients’ mutated stem cells are destroyed via chemotherapy, and healthy stem cells from a donor are infused into the bloodstream. These new stem cells travel to the bone marrow and start producing healthy stem cells. The patient’s own healthy stem cells can also be collected and reinfused.

The following complications are associated with CLL: 

• Frequent Infections: As the number of healthy white blood cells is significantly reduced in CLL, there is an increased risk of contracting bacterial, fungal or viral infections.
• Autoimmune Diseases: There is an increased risk of developing autoimmune diseases in persons with CLL. They are conditions in which the immune system mistakenly attacks healthy cells.
• Other Cancers: People with CLL have an increased risk of developing other forms of cancer including skin, lung, and colon cancer, due to a compromised immune system.
• Anaemia: Anaemia is a common complication of CLL due to loss of healthy blood cells.

As there are few risk factors for CLL and most of them cannot be avoided, there is no known way to prevent CLL. However, minimising chemical exposure can prove to be beneficial. Maintaining a healthy lifestyle by exercising regularly, eating a balanced diet and stress management can help keep the immune system strong and more resilient to disease.

Can chronic lymphocytic leukaemia metastasise?

Chronic lymphocytic leukaemia does not usually metastasise like other cancers, but it can spread through the lymphatic system, potentially leading to complications in specific organs.

Is CLL considered hereditary?

Although CLL is not considered hereditary, individuals with a family history of the condition are at a slightly higher risk. 

Can CLL patients participate in physical activities or sports?

Patients can participate in physical activities and sports, provided the intensity is controlled and not excessive. For a high quality of life, exercise is always advised, but it should be discussed with a doctor.

What role does diet play in managing CLL symptoms?

Although there is no specific diet for patients with chronic lymphocytic leukaemia, a balanced diet can help improve energy levels and overall quality of life. Consulting with a nutritionist can provide guidance on foods that may be beneficial for managing CLL.

Reviewed By Dr. Nivedita Dhingra- Associate Director - Medical Oncology (Haematology, Hemato–Oncology, BMT) Bone Marrow Transplant, Cancer Care / Oncology on 12 Dec 2024.