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 a family history of the disease.[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 and 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 occurs 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]
| Other names | B-cell chronic lymphocytic leukemia (B-CLL)[1] |
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| Peripheral blood smear showing CLL cells | |
https://en.wikipedia.org/wiki/Chronic_lymphocytic_leukemia
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