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Departments Health Matters
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Health Matters Chronic lymphocytic leukemia: A slow progression disease with a good prognosisMy mother-in-law has chronic lymphocytic leukemia. While she is in good health now and has regular check-ups with her doctor, what does the future hold in store for her? Chronic lymphocytic leukemia (CLL) is a disease in which too many white blood cells, called lymphocytes (LIM-fo-sites), are produced by the bone marrow. Lymphocytes make antibodies in response to the presence of bacteria and other foreign infectious agents in the body. Antibodies, in turn, neutralize and destroy these infectious organisms. In people with CLL, the lymphocytes are abnormal and may not produce antibodies, making CLL sufferers more susceptible to infection in the late stages of their disease. "CLL generally occurs in people 60 years of age or older," says Lewis R. Weintraub, MD, a hematologist at Boston Medical Center and a professor of medicine at the Boston University School of Medicine, "and is often detected fortuitously through blood work obtained during a routine exam." In the early stages of CLL, a patient may experience no symptoms at all and, says Weintraub, the disease may remain indolent for years and pose no problems that require treatment. As the disease progresses, however, symptoms begin to appear. These symptoms often occur in progressive stages as the leukemia cells slowly spread to other parts of the body. Stage 0 exists when there are too many lymphocytes only in the blood and bone marrow, but generally no other symptoms appear. In Stage I, clusters of lymph nodes in the underarm, pelvis, neck, and abdomen may enlarge. Stage II CLL occurs when the liver and spleen are swollen. The disease has progressed to Stage III when there are too few red blood cells, causing anemia. Stage IV CLL is when, in addition to all of these symptoms, there are too few platelets in the blood, making it difficult for the blood to clot. "Life expectancy for patients in Stage 0, with no symptoms, is 10 to 15 years," says Weintraub. "We generally don't treat patients in the early stages of the disease, especially if they have no symptoms. Previous studies have demonstrated that the early initiation of therapy in the asymptomatic patient does not result in a significant impact on length of life." Weintraub says treatment for CLL is based on the stage of the disease. Patients with early stage CLL are generally seen by their physician every few months and have blood drawn to determine their blood cell count. As the CLL stages progress, the treatment may involve the use of chemotherapeutic agents to kill the leukemic cells. These drugs can be administered on an outpatient basis. Bone marrow transplants are generally not an option because of the age of CLL patients. Radiation is used occasionally in some cases to reduce the size of large, localized, and painful lymph nodes. Some patients may develop an aggressive form of the disease, called refractory CLL, and no longer respond to treatment, eventually leading to their death. However, says Weintraub, since this may be an indolent disease of the older age group, many patients may die of another disease unrelated to their leukemia.
"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on lymphocytic leukemia or other health matters, call 638-6767. |
