Chronic lymphocytic leukemia (CLL)

Chronic lymphocytic leukemia (CLL) is a type of leukemia that causes your body to make abnormal white blood cells (lymphocytes) in your bone marrow. As the number of these abnormal cells grow, there is less room for healthy white and red blood cells and platelets. The cells can also spread to your lymph nodes, spleen, or liver. Because these white blood cells are not able to effectively defend the body from infections, you can experience illnesses, anemia, and bleeding.

CLL is the most common type of leukemia in adults. It tends to occur later in life, on average around age 70. This type of leukemia may be chronic and progress very slowly, or it can spread quickly and require therapy. Your treatment will depend on how the disease progresses.

Penn Medicine’s blood cancer care experts specialize in treating CLL. Although there’s no cure for the disease, therapies can allow you to live without symptoms, known as remission. Our experts have helped develop many of the current therapies for blood cancers, and we lead the largest bone marrow transplant program in our region. We also offer newer approaches that allow older adults to safely receive blood cancer therapies. With deep-rooted insights and experience, we can recommend the best treatment strategy for you.

One of the most common symptoms of CLL is enlarged lymph nodes in your neck, chest, or groin. This happens when lymphocytes build up in the nodes, causing them to swell. However, having swollen lymph nodes doesn’t necessarily mean that you have CLL because they’ll temporarily become enlarged when they produce antibodies to fight an infection. Other signs of CLL include:

• Fatigue and lethargy
• Night sweats
• Unexplained weight loss
• Unusual fullness after a meal
• Abdominal pain or swelling
• Fever and infections
• Bruising or bleeding, like nosebleeds or bleeding gums

Staging your chronic lymphocytic leukemia, along with knowing its clinical behavior, will help us create a treatment plan specific to you. CLL stages are determined using the Rai staging system:

• Stage 0: In this stage, there are circulating CLL cells without other abnormalities.
• Stage I: Your lymph nodes are involved.
• Stage II: Your spleen is involved.
• Stage III: You are anemic.
• Stage IV: You have low platelets.

It's important to know that the Rai staging system is different from other staging systems. Traditional, solid tumor staging may predict prognosis, but under the Rai system, higher stages doesn’t necessarily mean you have a poorer outlook. Doctors use the Rai staging system along with other factors to predict prognosis.

If you were diagnosed at another health care center and are coming to Penn Medicine for treatment or a second opinion, additional diagnostic tests may be necessary.

We use specific diagnostic imaging tools, tests, and procedures that are often more modern than what is available elsewhere. The results of these tools help us develop your personalized treatment plan.