Chronic Lymphocytic Leukemia - The Leukemia & Lymphoma Society

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Complications: CLL or CLL Treatment Infection. Infections are a common complication for people with CLL. Because of this high risk of infections, immediate vaccination for pneumococcal pneumonia with Prevnar 13® (repeated every 5 years) and a yearly flu vaccine is recommended. CLL patients do not respond well to vaccines due to their immune system depression. CLL patients should never receive live vaccines (such as the shingles vaccine). A higher risk of infection is caused by { { The inability of the person’s CLL cells to make antibodies needed to fight infections { { The effect of chemotherapy, which causes reduced cell counts for certain infectionfighting white cells in the blood, specifically neutrophils and monocytes. Antibiotic therapy is usually required to treat bacterial or fungal infections during the course of the disease. People who get recurrent infections may also receive injections of immunoglobulin (gamma globulin) on a regular basis to correct the immune deficiency. While immunoglobulin is expensive, it does have benefit in decreasing the frequency of infections in CLL patients with low levels of this in the blood. CLL-related low blood counts are often efficiently corrected by CLL therapy. However, the use of white cell growth factors may benefit patients who experience prolonged low white cell counts after treatment. Examples of white cell growth factors are { { Granulocyte-colony stimulating factor (G-CSF) (filgrastim [Neupogen®] or pegfilgrastim [Neulasta®]) that can increase the number of neutrophils { { Granulocyte-macrophage colony-stimulating growth factor (GM-CSF) (sargramostim [Leukine®]) that can increase the number of neutrophils and monocytes. Anemia. Anemia (low numbers of red cells) is a common side effect of chemotherapy. Some people with CLL may need blood transfusions. Richter Transformation. In about 3 to 5 percent of people with CLL, the disease transforms into an aggressive lymphoma because of a change in the characteristics of the CLL cells. This is much more common in IVgH-unmutated CLL. This pattern is referred to as a “Richter transformation” or “large cell transformation.” People with this type of CLL may have significantly enlarged lymph nodes, and may have fevers and weight loss. Tumors of lymphocytes may also develop in parts of the body other than the lymph nodes. Richter transformation is treated with aggressive chemotherapy and reduced-intensity allogeneic transplantation if feasible. Outcome for patients with Richter transformation is generally poor unless it is diagnosed prior to receiving a lot of treatment for CLL. page 18 I 800.955.4572 I www.LLS.org
Prolymphocytes. About 15 percent of people with CLL have leukemia cells that are a mix of lymphocytes and another type of white cell, called a “prolymphocyte” (see Figure 3, Panel D). Most people with this type of CLL follow a similar course to that of other people with CLL. However, for a relatively small subset of patients with this type of CLL, the blood cells may become mainly composed of prolymphocytes; the spleen may enlarge further, and the disease may become less responsive to treatment. In these cases, individuals are encouraged to talk to their doctors about the potential benefits of treatment in a clinical trial. Lymphocytes Panel A Panel B Panel C Panel D Figure 3. I Panel A shows a normal lymphocyte in the blood film of a healthy person. Panel B shows the increased frequency of lymphocytes in the blood film of a patient with CLL. Panel C shows the appearance of large granular lymphocytes in a patient with large granular lymphocytic leukemia (the arrows point to the cluster of granules in the cells), and Panel D shows the cells of prolymphocytic leukemia, which are larger than those in Panels A and B and have a light area in their nucleus, called a “nucleolus” (see arrow). This structure in the nucleus is a sign of a more immature or primitive cell. Autoimmune Hemolytic Anemia. Some people with CLL produce a type of antibody that works against their own cells. These “autoantibodies” are usually directed against the patient’s red cells and causes them to be removed rapidly from the blood. This condition, called “autoimmune hemolytic anemia,” can worsen the effects of already low red cell counts. The “antiglobulin test” or “Coombs’ test” is used to identify the autoantibodies. Less often, the antibody works against the platelets. This condition, called “immune thrombocytopenia,” Chronic Lymphocytic Leukemia I page 19
Page 1 and 2: Chronic Lymphocytic Leukemia JUNE D
Page 3 and 4: Table of Contents 2 Introduction 2
Page 5 and 6: along with a cancer diagnosis. LLS
Page 7 and 8: We’d Like to Hear From You. We ho
Page 9 and 10: etween herbicides used in Vietnam a
Page 11 and 12: infrequently, cause an increase in
Page 13 and 14: Chromosomal Changes. Certain chromo
Page 15 and 16: Treatment Current therapies do not
Page 17 and 18: Chemotherapy. Chlorambucil (Leukera
Page 19: Table 3. Some Drugs Used to Treat C
Page 23 and 24: Kinase Inhibitor Therapy. Kinases a
Page 25 and 26: The National Cancer Institute-spons
Page 27 and 28: Table 5. CLL and Related Diseases L
Page 29 and 30: { { The neutrophils and monocytes a
Page 31 and 32: Medical Terms Allogeneic Stem Cell
Page 33 and 34: Bone Marrow Biopsy. A test to exami
Page 35 and 36: e counted. One use of flow cytometr
Page 37 and 38: HLA. The abbreviation for “human
Page 39 and 40: egg or the sperm and can be transmi
Page 41 and 42: Promyelocyte. A cell that is formed
Page 43 and 44: More Information Free LLS publicati
Page 45 and 46: Notes Chronic Lymphocytic Leukemia
Page 47 and 48: REACH OUT TO OUR INFORMATION SPECIA

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