Chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults in the Western world. It is characterized by excessive production and accumulation of non-functional lymphocytes, specifically of the B cell type, in the bone marrow, peripheral lymph nodes and blood. This excess of lymphocytes gradually weakens the immune system, leading to an increased risk of infections, anemia and bleeding, as well as potential damage to other organs. CLL is often diagnosed incidentally during routine blood tests for other health problems because it can be asymptomatic in the early stages. Thanks to advances in treatment and a better understanding of the mechanisms of CLL development, this disease is more treatable, although we still find difficult-to-treat or non-responsive cases.

What is CLL

Chronic lymphocytic leukemia is a cancer that begins in white blood cells known as lymphocytes, specifically targeting B lymphocytes. This form of cancer is the result of tumor transformation, in which mature lymphocytes change into tumor cells. These cells, thanks to their exceptional ability to survive division, which is in contrast to normal lymphocytes, which have not undergone such a transformation.

Chronic lymphocytic leukemia tumor cells are problematic because they escape the control of the body's immune system. They lose their original functionality and instead multiply uncontrollably and do not disappear naturally. Their constant proliferation and resistance to extinction leads to damage to the body by taking up space and resources that would otherwise be intended for healthy cells.

As a result of this process, there is an accumulation of tumor cells, which expand and gradually infiltrate various organs, including lymph nodes, spleen and liver. In addition, these tumor cells are always present in the bone marrow, where they seriously disrupt the process of blood formation. This condition suppresses the production of healthy white and red blood cells and platelets, leading to serious health complications such as anemia, increased susceptibility to infections, and blood clotting problems.

Unlike acute leukemia, which progresses rapidly and requires immediate treatment, CLL can develop slowly and in some cases does not require immediate therapeutic intervention. This feature allows doctors to often choose a "watch and wait" strategy for asymptomatic patients. Compared to other forms of lymphomas and leukemias, CLL is unique in its biology, clinical course and response to treatment, which underlines the need for an individualized approach to the diagnosis and management of the disease.

A form of chronic lymphocytic leukemia (CLL) in which no clonal lymphocytes are present in the peripheral blood or bone marrow, but lymph nodes or other organs are affected, is called small lymphocytic lymphoma (SLL). According to the World Health Organization (WHO) classification, CLL and SLL are considered the same disease, known as CLL/SLL, and the treatment for the two forms is the same. This means that approaches used in the treatment of CLL, including chemotherapy, targeted therapy or immunotherapy, are also applicable in the treatment of SLL. The main difference between CLL and SLL is where the disease primarily manifests - CLL is characterized by an increased number of lymphocytes in the blood, while SLL is manifested by enlarged lymph nodes without a significant increase in the number of lymphocytes in the blood.

Symptoms of CLL

Symptoms of leukemia can be diverse and often develop gradually. In some cases, they can be mild or non-specific, which can make it difficult to identify them early.

Many patients are diagnosed accidentally during routine blood tests, which highlights the importance of regular medical check-ups.

Description of some of the most common symptoms associated with leukemia:

Fatigue and weakness

One of the most common symptoms is chronic fatigue, which is not associated with excessive exhaustion and does not improve with rest. This fatigue is the result of anemia, i.e. the lack of red blood cells that carry oxygen to the tissues of the body.

Frequent infections and fever

Due to insufficient production of functional white blood cells that fight infections, patients with leukemia are at increased risk of developing infections, including severe or recurrent infections. They may also experience fever or chills as signs of infection.

Increased bleeding or bruising

A lack of platelets (thrombocytopenia) makes leukemia patients more prone to bleeding and bruising, even from minor or unknown causes. They may also see small red spots on the skin (petechiae), which are the result of small hemorrhages under the skin.

Enlarged lymph nodes

Many patients with leukemia notice enlarged lymph nodes, especially in the neck, armpit or groin area. These enlarged nodes are usually painless.

Enlargement of the liver or spleen

The accumulation of leukemia cells can lead to enlargement of the liver or spleen, which can cause a feeling of fullness or pressure in the abdomen, or pain.

Bone or joint pain

Leukemic cells can accumulate in the bone marrow and cause pain or discomfort in the bones or joints.

Weight loss and loss of appetite

Unusual weight loss without a change in diet or exercise regimen can also be a sign of leukemia. Loss of appetite may also occur.

It is important to note that these symptoms are not specific to leukemia and may indicate other health problems. Therefore, when they occur, it is important to seek medical help to make an accurate diagnosis.

Complete blood count (CBC), cytogenetic examination and peripheral blood smear examination are the basic diagnostic tests for the identification of leukemia, where abnormal numbers of white and red blood cells indicate the possible presence of the disease and microscopic examination reveals abnormal or immature cells. Bone marrow biopsy, cytogenetic testing, and immunophenotyping are then used to confirm the diagnosis and specify the type of leukemia by identifying genetic abnormalities and cell surface markers.

Have you experienced symptoms that could indicate CLL and want an accurate diagnosis? Our facility with advanced diagnostic equipment is ready to help you. Do not hesitate to contact us so that together we can determine the diagnosis and find the best possible treatment for you.

Treatment of CLL

Chronic lymphocytic leukemia (CLL) is not treated immediately after diagnosis. If there are no active symptoms or if the disease does not progress, a "watch and wait" or "active surveillance" strategy is chosen, which means regular check-ups and blood tests to monitor the development of the disease. This approach allows doctors to evaluate the need for treatment based on the dynamics of the disease while minimizing the potential side effects of premature therapy.

Treatment becomes necessary when clear indicators of disease progression appear or when the patient begins to feel a deterioration in his health.

• The main reasons for starting treatment include:
• Enlarging lymph nodes, liver or spleen
• Decreasing number of red blood cells or platelets
• Clinical signs such as fevers, weight loss or night sweats
• A rapid increase in the number of white blood cells

The main goal of CCL treatment is to slow down the growth of tumor cells. This step is critically important because it reduces the burden that tumor cells place on the body while allowing healthy cells and tissues to function. By achieving this goal, we try to create conditions in which the patient can live a more fulfilling life without the constant deterioration of the condition caused by the disease.

Another inseparable goal is to achieve a long period of remission. Remission of the disease represents a state in which there are no active signs of the disease, which is confirmed by basic laboratory and clinical examinations. In practice, this means that patients do not have obvious symptoms of the disease and their laboratory values return to the normal range. This condition is often seen as a significant success in treatment, as it allows patients to live for long periods without significant limitations caused by their medical condition.

Long-term remission is crucial not only for improving the quality of life of patients, but also for prolonging their overall survival. Multiple treatment strategies are used to achieve this goal, including chemotherapy, targeted therapy, and immunotherapy. Each of these methods aims not only to suppress the activity of tumor cells, but also to minimize the side effects of treatment in order to allow patients to lead as normal a life as possible.

Ultimately, all of these goals are aimed at ensuring that patients with CLL can live fuller and longer lives despite the challenges that the disease brings. By integrating the latest research, personalized treatment strategies and holistic patient care, we strive to achieve these goals and push the boundaries of what is possible in CLL treatment.

The decision to start treatment is based on a comprehensive assessment of the patient's overall health, symptoms, blood test results and other diagnostic examinations. The approach to CLL treatment is always individualized, taking into account the latest knowledge and available therapeutic options to provide patients with the most effective and gentle treatment.

Our office focuses on providing specialized care for patients with CLL, using the most modern technologies and methods. Our focus on innovation and personalized treatment can help you achieve better health outcomes. Contact us so we can start working on your recovery plan.

Basic treatment procedures

Treatment of chronic lymphocytic leukemia varies depending on the stage of the disease, the patient's overall health and the presence of symptoms. With the advent of new therapies, treatment options have expanded, offering patients better results and a better quality of life.

Chemotherapy

Chemotherapy is a traditional method of treating CLL that uses chemicals to kill cancer cells in the body. This method is often used in several stages of the disease, especially if it is necessary to quickly control a rapidly progressive form of leukemia. The main advantage of chemotherapy is its effectiveness in reducing the number of leukemic cells, which can lead to remission of the disease. However, the disadvantage is that chemotherapy agents cannot distinguish between cancerous and healthy cells, which can cause significant side effects such as fatigue, infections or bone marrow damage.

Targeted therapy

Targeted therapies represent a modern approach in the treatment of various types of cancer, including chronic lymphocytic leukemia (CLL), which targets specific molecular targets responsible for the growth, division and survival of cancer cells. Compared to traditional chemotherapy, targeted therapies make it possible to target cancer cells more precisely in order to limit damage to healthy cells and minimize side effects.

Immunotherapy

Immunotherapy is a treatment strategy that strengthens or restores the immune system's ability to recognize and attack cancer cells. It is mainly used in patients who do not respond to traditional treatment methods or when the disease recurs. The advantage of immunotherapy is its potential to target the immune system against cancer cells with relatively fewer side effects compared to chemotherapy. A disadvantage may be the variability in patients' response to treatment and the possibility of autoimmune reactions.

Stem cell transplantation

Stem cell transplantation is an intensive procedure that is used in advanced stages of CLL or when the disease relapses several times after other forms of treatment. The main purpose of a bone marrow transplant is to give the patient a new, fully functional immune system that can assist in the fight against cancer. In this method, the patient's damaged blood-forming cells are replaced with healthy stem cells, potentially leading to long-term remission or even a cure. The main advantage is the possibility of a radical improvement or complete disappearance of the symptoms of the disease. Disadvantages include a high risk of complications, a long recovery period and the risk of transplant rejection.

Corticotherapy

Corticotherapy uses corticosteroids, which are strong anti-inflammatory drugs, in the treatment of CLL mainly to relieve symptoms and control complications associated with an excessive immune response or inflammation. These drugs can be used alone or in combination with other forms of treatment, such as chemotherapy or immunotherapy, especially in situations where it is necessary to reduce the number of leukemia cells quickly or to treat complications such as autoimmune manifestations of CLL. The main advantage of corticotherapy is the rapid onset of action, improvement of symptoms and reduction of inflammation. Disadvantages include potential side effects with long-term use, such as osteoporosis, weight gain, increased risk of infections, and the possibility of diabetes. Because of these risks, corticosteroids are used cautiously and under close medical supervision, usually in short-term cycles or as adjunctive therapy along with other therapies.

Radiotherapy

Radiotherapy, although less commonly used in the treatment of CLL, may be indicated in specific situations, for example to relieve pain or to reduce the size of enlarged lymph nodes that are causing complications or discomfort. This method uses high-energy radiation to destroy cancer cells in a targeted area. The advantage of radiotherapy is the ability to precisely target areas affected by the disease with minimal impact on the surrounding healthy tissue. Disadvantages may be limited effectiveness in broad-spectrum treatment of CLL, as it is a systemic disease, and potential side effects associated with radiation exposure, such as local skin reactions or temporary reductions in blood cell counts.

Conclusion

If you are suffering from symptoms that could be associated with chronic lymphocytic leukemia and are looking for a thorough and accurate diagnosis, our specialist practice is available to support you. We offer personalized services in the area of identifying the most effective course of treatment, including the latest medical knowledge, complementary treatment methods and nutritional counseling to improve your quality of life and health.

We are ready to examine your symptoms in detail and work with you to establish a diagnosis and treatment plan. Contact us today.