LYMPHOCYTIC

About Your Diagnosis
Chronic lymphocytic leukemia (CLL) is a malignant disease that results in abnormal collection of relatively mature lymphocytes in the bone marrow, lymph nodes, liver, spleen, and other organs, resulting in their enlargement. As the disease progresses, the accumulation of abnormal lymphocytes in the bone marrow decreases production of normal blood cells, causing anemia (low red blood cell count), leukopenia (low white blood cell count), and thrombocytopenia (low platelet count). Genetic factors play an important role in causing CLL. There is an increased rate of CLL in some families. Relatives of patients with CLL are at higher risk for this disease than is the general population. The normal genotype for humans is 23 pairs of chromosomes. One third of patients with CLL have an extra chromosome 13, resulting in trisomy 13. Other common chromosome abnormalities include 14q+, 13q+, and 12q+. Radiation does not increase risk for CLL. CLL is the most common type of leukemia in western countries. The disease typically occurs among patients older than 50 years and is unusual among persons younger than 30 years. The disease effects men twice as frequently as women. CLL is a malignant not an infectious disease, so it is not transmitted by means of casual contact. Approximately 25% of patients have no symptoms at the time of diagnosis. These patients have blood lymphocytosis (increased number of lymphocytes), enlarged lymph nodes, or an enlarged spleen found during a routine examination or evaluation of an apparently unrelated disease. The most common symptom that causes a patient to consult a physician is fatigue or a vague sense of ill-being. Sometimes enlarged lymph nodes or the development of an infection is the initial symptom. Some patients describe easy bruising or other bleeding problems.

Living With Your Diagnosis
Patients have normal life expectancy in the early stages of the disease. Approximately 25% of patients have no symptoms at the time of the diagnosis. As the disease progresses, however, patients may experience discomfort because of large lymph nodes and splenomegaly. Anemia and thrombocytopenia can give rise to symptoms of fatigue, generalized weakness, easy bruising, and bleeding. Immune system disturbances in CLL give rise to the formation of antibodies against one’s own red blood cells and platelets, causing what is called autoimmune hemolytic anemia and autoimmune thrombocytopenia. In these conditions growth of malignant lymphocytes suppresses production of normal blood cells and results in anemia and thrombocytopenia. Immune dysfunction and hypogammaglobulinemia increase risk for bacterial, fungal, and atypical viral infections. Most patients with CLL die of either severe infections or unrelated causes.

Treatment
Patients are treated if they have aggressive CLL, defined by generalized symptoms, anemia, thrombocytopenia, painful enlargement of the lymph nodes and spleen, or frequent infections. Treatment is with chemotherapy. Single agents or combinations of alkylating agents, purine analogs, and steroids are used. Chlorambucil and cyclophosphamide with or without prednisone are effective in controlling CLL. Fludarabine and cladribine (2- CDA) also are effective in the management of new and refractory cases of CLL. In addition to chemotherapy, radiation therapy to the spleen and lymphoid tissue can control the symptoms. Bone marrow transplantation is potentially curative treatment of younger patients with CLL. Common side effects of chemotherapy include nausea, vomiting, diarrhea, and mouth ores. Chemotherapy lowers normal blood counts, and patients can contract infections, including pneumonia and blood infections. Patients who have increased weakness and lack of energy because of low red blood cell counts need blood transfusions. Platelet counts also can drop, increasing risk for bleeding. Chemotherapy can cause abnormalities in the genetic material of cells, which increases risk for cancer of the organs.

The DOs
• Participate in your chemotherapeutic regimen as directed.
• Take antibiotics as directed if you have an infection.
• Avoid dairy products, fresh fruits, and vegetables during the periods of myelosuppression that follow chemotherapy.

The DON’Ts
• Do not use medications more frequently than recommended.
• Avoid eating uncooked vegetables, fruits, and milk products, because these products harbor bacteria that are not harmful for healthy persons but can cause severe infections among patients with low white blood cell counts.
• Avoid strenuous exercise if you have low blood cell counts.
• Stop exercising if you have any chest pain or shortness of breath. Your red blood cell count may be very low, and ischemia (lack of blood) of the vital organs can develop.

When to Call Your Doctor
• If you have a fever, abdominal pain, rapid increase in size of your spleen or lymph glands, or bleeding from the gums or any other orifices.