Back ابيضاض الدم الليمفاوي المزمن Arabic Hronična limfocitna leukemija BS Leucèmia limfocítica crònica Catalan Kronisk lymfatisk leukæmi Danish Chronische lymphatische Leukämie German Leucemia linfática crónica Spanish لوسمی مزمن لنفاوی Persian Krooninen lymfaattinen leukemia Finnish Leucémie lymphoïde chronique French לוקמיה לימפוציטית כרונית HE

Chronic lymphocytic leukemia

"B-cell CLL" redirects here. For the gene family, see B-cell CLL/lymphoma.
Chronic lymphocytic leukemia
Other namesB-cell chronic lymphocytic leukemia (B-CLL)[1]
Peripheral blood smear showing CLL cells
SpecialtyHematology and oncology
SymptomsEarly: None[2]
Later: Non-painful lymph nodes swelling, feeling tired, fever, weight loss[2]
Usual onsetOlder than 50[3]
Risk factorsFamily history, Agent Orange, certain insecticides[2][4]
Diagnostic methodBlood tests[5]
Differential diagnosisMononucleosis, hairy cell leukemia, acute lymphocytic leukemia, persistent polyclonal B-cell lymphocytosis[5]
TreatmentWatchful waiting, chemotherapy, immunotherapy[4][5]
PrognosisFive-year survival ~88% (US)[3]
Frequency904,000 (2015)[6]
Deaths60,700 (2015)[7]

Chronic lymphocytic leukemia (CLL) is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell).[2][8] Early on, there are typically no symptoms.[2] Later, non-painful lymph node swelling, feeling tired, fever, night sweats, or weight loss for no clear reason may occur.[2][9] Enlargement of the spleen and low red blood cells (anemia) may also occur.[2][4] It typically worsens gradually over years.[2]

Risk factors include having a family history of the disease, with 10% of those who develop CLL having such ancestry.[2][9] Exposure to Agent Orange, certain insecticides, sun exposure, exposure to hepatitis C virus, and common infections are also considered risk factors.[4][9] CLL results in the buildup of B cell lymphocytes in the bone marrow, lymph nodes, and blood.[4] These cells do not function well and crowd out healthy blood cells.[2] CLL is divided into two main types:

  • Those with a mutated IGHV gene
  • Those without.[4]

Diagnosis is typically based on blood tests finding high numbers of mature lymphocytes and smudge cells.[5]

Early-stage CLL in asymptomatic cases responds better to careful observation, as there is no evidence that early intervention treatment can alter the course of the disease.[10] Immune defects occur early in the course of CLL and these increase the risk of developing serious infection, which should be treated appropriately with antibiotics.[10] In those with significant symptoms, chemotherapy, immunotherapy, or chemoimmunotherapy may be used.[4] Depending on the individual's age, physical condition, and whether they have the del(17p) or TP53 mutation, different first line treatments may be offered.[11] As of 2021, BTK inhibitors such as ibrutinib and acalabrutinib are often recommended for first line treatment of CLL.[12] The medications fludarabine, cyclophosphamide, and rituximab were previously the initial treatment in those who are otherwise healthy.[13]

CLL affected about 904,000 people globally in 2015 and resulted in 60,700 deaths.[6][7] In 2021, the estimated incidence of CLL in the United States is 21,250 new cases and 4,320 deaths.[14] The disease most commonly occurs in people over the age of 65, due to the accumulation of genetic mutations that occur over time.[3][15] Men are diagnosed around twice as often as women (6.8 to 3.5 ratio).[16] It is much less common in people from Asia.[4] Five-year survival following diagnosis is approximately 83% in the United States.[3] It represents less than 1% of deaths from cancer.[7]

  1. ^ O'Brien S, Gribben JG (2008). Chronic Lymphocytic Leukemia. CRC Press. p. 19. ISBN 9781420068962.
  2. ^ a b c d e f g h i j "Chronic Lymphocytic Leukemia Treatment". National Cancer Institute. 26 October 2017. Retrieved 19 December 2017.
  3. ^ a b c d "Chronic Lymphocytic Leukemia – Cancer Stat Facts". seer.cancer.gov. Retrieved 9 September 2022.
  4. ^ a b c d e f g h Kipps TJ, Stevenson FK, Wu CJ, Croce CM, Packham G, Wierda WG, et al. (January 2017). "Chronic lymphocytic leukaemia". Nature Reviews. Disease Primers. 3: 16096. doi:10.1038/nrdp.2016.96. PMC 5336551. PMID 28102226.
  5. ^ a b c d Ferri FF (2017). Ferri's Clinical Advisor 2018 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 750. ISBN 9780323529570.
  6. ^ a b Vos, Theo; et al. (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  7. ^ a b c Wang, Haidong; et al. (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  8. ^ Boelens J, Lust S, Vanhoecke B, Offner F (February 2009). "Chronic lymphocytic leukaemia". Anticancer Research. 29 (2): 605–615. PMID 19331210.
  9. ^ a b c Cite error: The named reference Hall2018 was invoked but never defined (see the help page).
  10. ^ a b Stilgenbauer S, Furman RR, Zent CS (2015-05-01). "Management of chronic lymphocytic leukemia". American Society of Clinical Oncology Educational Book. American Society of Clinical Oncology. Annual Meeting (35): 164–175. doi:10.14694/EdBook_AM.2015.35.164. PMID 25993154.
  11. ^ Hallek M (November 2019). "Chronic lymphocytic leukemia: 2020 update on diagnosis, risk stratification and treatment". American Journal of Hematology. 94 (11): 1266–1287. doi:10.1002/ajh.25595. PMID 31364186. S2CID 199000131.
  12. ^ Patel K, Pagel JM (April 2021). "Current and future treatment strategies in chronic lymphocytic leukemia". Journal of Hematology & Oncology. 14 (1): 69. doi:10.1186/s13045-021-01054-w. PMC 8074228. PMID 33902665.
  13. ^ Hallek M (September 2017). "Chronic lymphocytic leukemia: 2017 update on diagnosis, risk stratification, and treatment". American Journal of Hematology. 92 (9): 946–965. doi:10.1002/ajh.24826. PMID 28782884.
  14. ^ "Key Statistics for Chronic Lymphocytic Leukemia". www.cancer.org. Retrieved 2021-11-29.
  15. ^ "Genes and Cancer". Archived from the original on 2021-11-16.
  16. ^ Grywalska E, Zaborek M, Łyczba J, Hrynkiewicz R, Bębnowska D, Becht R, et al. (November 2020). "Chronic Lymphocytic Leukemia-Induced Humoral Immunosuppression: A Systematic Review". Cells. 9 (11): 2398. doi:10.3390/cells9112398. PMC 7693361. PMID 33147729.

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