Chronic lymphocytic leukemia

Overview

Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults where the bone marrow makes too many lymphocytes (a type of white blood cell). This type of cancer usually progresses slowly.

The early signs of CLL and other chronic leukemias of lymphocytes may be like the flu or other common diseases, including:

  • Painless swelling of the lymph nodes in the neck, underarm, stomach, or groin.
  • Feeling very tired.
  • Pain or fullness below the ribs.
  • Fever and infection.
  • Weight loss for no known reason.

Be aware that these symptoms could be due to conditions other than chronic lymphocytic leukemia, so it’s best to see a doctor right away.

Our approach

Northwell Health takes a sophisticated, comprehensive approach to treating chronic lymphocytic leukemia (CLL). Physicians focus on CLL at the Hematologic Oncology Center, part of Northwell Health Cancer Institute and home to one of the largest leukemia services programs in the United States. The center has a dedicated CLL research section. The highly regarded experts use the latest technology and research-backed therapies to treat newly diagnosed, relapsed and CLL and related diseases, including prolymphocytic leukemia, hairy cell leukemia and Natural Killer (NK) and NK-like T cell lymphocytosis.

At the Hematologic Oncology Center, the team offers the most advanced medical care to ensure an accurate CLL diagnosis and the best possible approaches to diagnosis for patients with less common diseases related to CLL, such as hairy cell leukemia, prolymphocytic leukemia and natural killer T (NKT) cell-large granular lymphocytic leukemia.

Highlights of CLL treatments and services include:

  • Personalized CLL treatments from a team of physicians with extensive experience with hematologic malignancies, particularly CLL.
  • Expert management of less common chronic leukemias of lymphocytes, including prolymphocytic and hairy cell leukemia and leukemias of NK and NK-like T cells.
  • Advanced therapies that deliver the best outcomes with the least impact on the body, including National Cancer Institute and highly selected pharmaceutical industry–sponsored clinical trials.

Multidisciplinary Treatment of Chronic Lymphocytic Leukemia (CLL) and Related Diseases

Within the first several days of a visit, the multidisciplinary team at the Hematologic Oncology Center will conduct comprehensive tests and develop a personalized cancer treatment program.

Each patient requires unique, personalized treatment planning, so the clinical care and research team meets regularly to discuss diagnosis and therapy. Team members hold weekly multidisciplinary conferences focused on developing and administering the best possible treatments for CLL and related diseases, such as hairy cell and prolymphocytic leukemia and diseases of NK and NK-like T cells. The physicians share ideas and optimal practices for delivering the best possible care.

The physicians have a distinguished research track record in studying this disease and have made major discoveries in this condition relating to prognosis. In addition, the CLL Research and Treatment Center has helped to develop innovative new treatments to benefit patients. Specialists review each treatment to constantly refine each patient’s CLL care and ensure treatment milestones are reached.

For patients for whom stem cell transplantation is the best strategy — a relatively minor but growing portion of patients with CLL — the Adult Bone Marrow and Stem Cell Transplant Program is available. The program is one of the largest in the New York metropolitan area, and is accredited by the Foundation for the Accreditation of Cellular Therapy (FACT).

Diagnosis

The first step to making a chronic lymphocytic leukemia diagnosis is usually a physical exam. The doctor will also consider personal and family medical history. If chronic lymphocytic leukemia is suspected, the patient will be sent for additional tests — usually administered on an outpatient basis — which include:

  • Complete blood count (CBC) with differential — Blood is drawn to measure the number of red blood cells, white blood cells and platelets in the blood. The amount of hemoglobin (substance in the blood that carries oxygen) and the hematocrit (the amount of whole blood that is made up of red blood cells) are also measured. The differential will count the different types of white blood cells that may be present.
  • Peripheral blood smear — A blood sample is checked for the number and kinds of white blood cells, the number of platelets and changes in the shape of blood cells.
  • Bone marrow aspiration and biopsy — A small sample of bone marrow and bone is removed. The sample is examined by a pathologist for signs of leukemia.
  • Immunophenotyping — A process used to identify cells, based on the types of antigens or proteins on the surface of the cell. This process is used to diagnose specific types of leukemia and lymphoma by comparing cancer cells to their normal couterparts. Flow cytometry and immunohistochemistry are the two tests used to provide optimal immunophenotyping.
  • Blood chemistry studies — A blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
  • Cytogenetic analysis — The chromosomes in the cells of a blood or bone marrow sample are examined. Abnormalities in the chromosomes could be a sign of leukemia.  Cytogenetics and a related procedure called fluorescence in-situ hybridization (FISH) are used to identify whether or not abnormal chromosomes are present. 
  • Molecular genetics — The molecular genetics laboratory looks for expressions of disease that may have escaped detection by other methods.

Imaging Tests

  • Chest X-rays — X-rays help doctors look for tumors in the chest and lungs or evidence of infection.
  • CT or CAT scan (computerized axial tomography) — More detailed than an X-ray, this procedure uses a combination of X-rays and computer technology to produce detailed images if needed.
  • MRI (magnetic resonance imaging) — A powerful magnet, radio waves and computer imaging combine to create highly detailed pictures of areas inside the body, if needed.
  • PET scan (positron emission tomography) — Small amounts of radioactive sugar are injected to highlight cancers and areas of infection and inflammation.

Recurrent Chronic Lymphocytic Leukemia

Recurrent chronic lymphocytic leukemia is leukemia that has recurred (returned) after going into remission. The CLL may come back in the blood, bone marrow, or other parts of the body.

With the data from these state-of-the-art tests for chronic lymphocytic leukemia diagnosis, the doctor will develop a customized treatment plan for each patient to achieve the best possible outcomes.

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