Chronic Lymphocytic Leukemia - Stages, Symptoms, Risk Factors, Causes, Diagnosis, and Treatment

What Is Leukemia?

Leukemia is a condition in which an excessive number of white blood cells (WBC) is seen in the blood. The bone marrow becomes hyperactive and produces an excessive number of cells. Though there are elevated levels of WBC, they are not functionally potent to carry out the regular activities in the body. It can occur in both acute and chronic conditions. If the condition occurs suddenly, then it is categorized as an acute condition, and if it takes a longer duration for progression, then it is categorized as chronic leukemia.

What Is Chronic Lymphocytic Leukemia?

Chronic lymphocytic leukemia is a monoclonal disorder in which there is an accumulation of an abnormal protein called M protein. M protein refers to the monoclonal protein present in the blood. If M proteins are present in urine or the blood, then it is an indicating sign for a disease or condition. These abnormal proteins are known to be formed within the bone marrow. The usual age of occurrence of this condition is around fifty years.

What Is the Epidemiology of Chronic Lymphocytic Leukemia?

Reports from The American Cancer Society show that there are more than twenty-one thousand and forty cases recorded every year. Asian countries like Japan and China have only a poor number of cases reported for chronic lymphocytic leukemia. In addition to this, males experience two times the risk for chronic lymphocytic leukemia when compared to women.

What Are the Stages of Chronic Lymphocytic Leukemia?

There are two types of staging systems that are used for categorizing chronic lymphocytic leukemia. They are:

• Rai-Sawitsky staging system.

• Binet staging system.

The condition of chronic lymphocytic leukemia is categorized as follows according to the Rai-Sawitsky staging system.

• Low Risk: Chronic lymphocytic leukemia occurs only in blood and bone marrow.

• Intermediate Risk: Chronic lymphocytic leukemia occurs along with the enlargement of the spleen and liver. It is seen along with the enlargement of lymph nodes in any site in the body.

• High Risk: Chronic lymphocytic leukemia occurs when anemia or thrombocytopenia occurs. Here, the hemoglobin level is less than 11gm per dL. The platelets are also known to decrease.

Chronic lymphocytic leukemia is categorized into the following stages in the Binet staging system.

• Stage A: In stage A, three or less than three lymph nodes are involved. The hemoglobin level is 10 g/dL or more.

• Stage B: In stage B, there are three or more than three lymph nodes involved. The hemoglobin levels are maintained the same as stage A.

• Stage C: In stage C, the hemoglobin levels are less than 10 g/dL.

What Are the Signs and Symptoms of Chronic Lymphocytic Leukemia?

Some patients do not experience any signs and symptoms during the early stage of chronic lymphocytic leukemia. The condition usually progresses gradually and can be identified in any blood examination done as a diagnostic procedure for any other purpose. Approximately twenty to fifty percent of patients do not experience any symptoms. The common signs and symptoms experienced by chronic lymphocytic leukemia patients are:

• Recurring infections.

• Night sweats.

• Enlarged liver, lymph nodes, or spleen.

• Abnormal bruising.

• Loss of appetite or early satiety.

• Fatigue.

• Abdominal fullness.

• Fever.

What Are the Risk Factors Associated With Chronic Lymphocytic Leukemia?

The various risk factors associated with chronic lymphocytic leukemia are:

• Age: Nearly nine out of ten people who are known to be affected by chronic lymphocytic leukemia are more than the age of fifty.

• Exposure to Agent Orange: Medical reports suggest that people who are affected by Agent Orange herbicide that was used during the Vietnam war had a higher level of risk for chronic lymphocytic leukemia.

• Occupational Hazard: People who are involved in farming activities for prolonged duration have a higher possibility of exposure to harmful pesticides. This will increase the risk of chronic lymphocytic leukemia.

• Family History: An individual who has a family history of chronic lymphocytic leukemia, they are at increased risk.

• Male Gender: The increased incidence of chronic lymphocytic leukemia in the male gender is reported by many medical researchers. However, the actual cause for a higher level of occurrence in males is not identified.

• Radon Exposure.

• Vitamin C deficiency might result in scurvy.

What Are the Causes of Chronic Lymphocytic Leukemia?

Chronic lymphocytic leukemia can occur due to various genetic mutations in an individual. Trisomy in chromosome 12 and any other type of deletions in the gene can also be the causative factor. In other cases, translocation is also known to contribute to the occurrence of chronic lymphocytic leukemia. In some individuals, genetic mutations that are abnormal might be inherited from the parents. Excessive exposure to a herbicide called Agent orange is known to be a hazardous cause for chronic lymphocytic leukemia. Some viral infections can also lead to chronic lymphocytic leukemia.

How Is Chronic Lymphocytic Leukemia Diagnosed?

The diagnosis of chronic lymphocytic leukemia requires blood examination and staging.

• Blood Examination: The blood analysis will reveal the increase in the number of white blood cells. A complete blood count can be done for this.

• Flow Cytometry and Immunophenotyping: This procedure helps in the identification of an exact number of increases in the number of lymphocytes in the blood. It also helps in determining the reason why there is an increase. The cause of other blood-related disorders, infections, and chronic lymphocytic leukemia can also be identified.

• Fluorescence In Situ Hybridization (FISH): In this procedure, the chromosomes that are present in the lymphocytes that are abnormal are identified. This procedure also plays a vital role in prognosis.

• Bone Marrow Biopsy: Since the bone marrow is under problematic condition, the biopsy of the bone marrow is taken and sent for laboratory analysis.

• Bone Marrow Aspiration: If there is an accumulation of abnormal fluids in the bone marrow, then it might result in health-related issues. To identify this, bone marrow aspiration is done.

The other methods that are used for the identification of chronic lymphocytic leukemia are computerized tomography (CT) and positron emission tomography (PET).

What Are the Treatment Options for Chronic Lymphocytic Leukemia?

The following treatment options are known to be beneficial for chronic lymphocytic leukemia.

• Natural Remedies: In the initial stages of chronic lymphocytic leukemia, the extracts of green tea can be helpful. It is known to contain a component called EGCG that has a beneficial effect of fighting against the condition of chronic lymphocytic leukemia.

• Chemotherapy: Chemotherapy is recommended only for patients who experience symptoms. The chemotherapy drugs are administered orally or through the parenteral route. These drugs are helpful in killing cancer cells. The drugs that are used for chemotherapy treatment are:

  • Ibrutinib.

  • Venetoclax.

  • Duvelisib.

  • Obinutuzumab.

  • Idelalisib.

  • Rituximab.

  • Ofatumumab.

• Immunotherapy: In immunotherapy, an individual's immune system is boosted to fight against the cancer cells. In this way, it becomes easier for the immune systems to detect the cancer cells and kill them.

• Bone Marrow Transplant: Bone marrow transplantation is a procedure in which the bone marrow is replaced with another bone marrow from a healthy donor. This procedure is also called stem cell transplantation. This method is recommended for acute conditions, but chronic cases can also be treated with it.

• Patients might also require psychological counseling for overcoming stress and anxiety due to life-threatening conditions like chronic lymphocytic leukemia. The doctors can also recommend alternate treatment options like yoga, meditation, massage, exercises, and relaxation techniques.

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