Chronic lymphocytic leukemia (CLL)

Chronic lymphocytic leukemia (CLL) is a type of leukemia that begins in the bone marrow. Individuals with CLL produce too many lymphocytes (white blood cells) in their bone marrow.

In blood cancers like CLL, these blood cells can become abnormal, and as their numbers grow, there is less room for healthy white and red blood cells, and platelets, to develop. The abnormal white blood cells are not able to effectively defend the body from infections, and can cause the person to experience infections/illness, anemia and bleeding.

CLL is the most common type of leukemia in adults. There are almost 16,000 people diagnosed with CLL each year. The average age of a patient with newly diagnosed CLL is 72 years.

As its name suggests, CLL can be a chronic disease and progress very slowly, or it can progress quickly and require therapy. Your treatment will depend on how your disease progresses.

When the lymph system produces antibodies or fights an infection, lymph nodes may become enlarged. This is normal. However, one of the most common symptoms of chronic lymphocytic leukemia (CLL) is swollen lymph nodes in the neck, chest or groin. If you have enlarged lymph nodes, it doesn't necessarily mean you have CLL. Other signs of CLL include:

• Fatigue
• Lethargy
• Night sweats
• Unexplained weight loss
• Unusual fullness after a meal
• Abdominal pain or swelling
• Fever and/or infection
• Bleeding
• Bruising

Diagnosing chronic lymphocytic leukemia (CLL) requires a physical examination and examination of the blood. This includes review of a peripheral blood smear by the physician to identify CLL cells under the microscope. Then, a leukemia diagnostic test called "flow cytometry" is used to confirm the molecular markers on those cells are consistent with CLL cells.

Genetic testing, cytogenetics and other markers can help us define prognosis and select appropriate therapies. In general, most patients can have a diagnosis based on a physical examination and blood test. Sometimes, a bone marrow biopsy may be necessary.

Here are more tests for CLL and exams that may be used to diagnose and stage the disease:

• A physical exam and full medical history evaluation
• A complete blood count (CBC)
• A flow cytometry test to confirm the diagnosis of CLL
• Peripheral blood smear
• Bone marrow aspiration and biopsy
• Genetic testing, cytogenetics and other markers to help deliver a prognosis

Staging CLL

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, traditional staging systems. More traditional, solid tumor staging systems may predict prognosis whereas Rai staging system doesn't necessarily mean you are at a poorer prognosis. Just because you are diagnosed at a higher stage doesn't mean your CLL cannot be managed. Our specialists will work with you to create a personalized treatment plan.

Getting A Second Opinion from Penn

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

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