What is Chronic Lymphocytic Leukemia?

Chronic lymphocytic leukemia (CLL) is a malignant tumor that originates in hematopoietic tissue. Tumor cells are monoclonal B lymphocytes, which resemble normal mature small lymphocytes and accumulate in blood, bone marrow, and lymphoid tissues.

Basic Information

English name

chronic lymphocytic leukemia, CLL

Visiting department

Hematology

Multiple groups

Immediate family members of patients with chronic lymphocytic leukemia

Common causes

May be related to long-term exposure to low-frequency magnetic fields, genetic factors, etc.

Common symptoms

Anemia, painless lymphadenopathy, or hepatosplenomegaly

Contagious

no

Causes of chronic lymphocytic leukemia

The etiology has not been fully defined, and environmental factors do not play a major role in the onset of chronic lymphocytic leukemia. Long-term exposure to low-frequency electromagnetic fields may be related to the onset of the disease. Asian countries and Western countries have a lower incidence of Asians than Europeans and Americans. The immediate family members of patients with chronic lymphocytic leukemia are three times more likely to develop the disease than men, and men are more susceptible than women. Occupy a certain position in the onset.

Clinical manifestations of chronic lymphocytic leukemia

Early symptoms are often asymptomatic, and patients are often referred for painless lymphadenopathy or an absolute increase in lymphocytes of unknown origin. Patients have non-specific manifestations such as mild fatigue and fatigue, and once in the advanced stage, they can show symptoms of weight loss, repeated infections, bleeding, and anemia in addition to systemic lymph nodes and splenomegaly. Due to the age of the susceptible population, patients often suffer from chronic lung disease, cerebrovascular disease, cardiovascular disease and other potential chronic diseases.

Lymphadenopathy

80% of patients have painless lymphadenopathy, which can be systemic, mild to moderate swelling, occasionally obvious swelling, non-adhesion to the skin, and often involves the neck, supraclavicular, axillary and groin areas.

Liver and spleen

Half of the patients had mild to moderate splenomegaly, with abdominal fullness, and reached the pelvic cavity in the late stage. Spleen infarction or spleen rupture may occur, and liver enlargement is rare.

3. Anemia and bleeding

Anemia or thrombocytopenia may occur as the disease progresses. In most cases, it is caused by leukocyte infiltration of bone marrow or the production of autoantibodies. Occasionally, splenomegaly causes hypersplenism.

4. Extranodal infiltration

Lymphocytes can infiltrate the skin, conjunctiva, lung, pleura, gastrointestinal tract, bones, nervous system, kidneys, and so on.

5. Complications

Immunodeficiency and immune disorder manifestations, such as conditional pathogenic pathogen infections, autoimmune diseases, and secondary tumors.

Chronic lymphocytic leukemia

Blood image

Leukocytes continued to increase 10 × 10 ⁹ / L, the proportion of lymphocytes 50%, and the absolute value of monoclonal lymphocytes 5 × 10 ⁹ / L. Anemia or thrombocytopenia may occur in the case of bone marrow infiltration of tumor cells, bone marrow suppression after treatment, immune destruction or lack of nutrients.

Bone marrow

Bone marrow hyperplasia is active and is occupied by tumor cells, accounting for more than 40%. The morphology is basically the same as that of peripheral blood. A bone marrow biopsy can help determine the extent of bone marrow involvement.

3. Lymph node biopsy

Lymph node pathology shows typical infiltration of small lymphocytes, and the cell morphology is consistent with lymphocytes in the blood.

4. Chromosome inspection

About 50% of patients have abnormal number and structure of chromosomes, most of which are abnormal on chromosomes 12, 14 and 13.

5. Immunological examination

Flow cytometry can be used to detect cell surface differentiation antigens, membrane surface immunoglobulins, and kappa and lambda light chains to determine whether cells are clonally proliferating and provide further typing.

Diagnosis of chronic lymphocytic leukemia

For elderly patients, recurrent infections, unexplained anemia, superficial lymphadenopathy, or hepatosplenomegaly, chronic lymphocytic leukemia should be suspected and examined. Combined with age, clinical manifestations, peripheral blood leukocytes> 10 × 10 ⁹ / L, lymphocyte ratio 50% or greater, absolute lymphocyte value> 5 × 10 ⁹ / L, bone marrow lymphocytes> 40% and mainly mature lymphocytes As well as the typical manifestations of lymphadenopathy, diagnosis is not difficult in most cases. Immunotyping is essential to help differential diagnosis.

Chronic lymphocytic leukemia treatment

Low-risk patients have mildly increased lymphocytes (<30 × 10 ⁹ / L, Hb> 120g / L, platelets> 100 × 10 ⁹ / L), non-diffuse infiltration of bone marrow has a long survival period, and patients with stable conditions can be regularly observed Symptomatic treatment. Patients should be actively treated when fever, marked weight loss, fatigue, anemia, thrombocytopenia, spleen or spleen area pain, lymphadenopathy with local symptoms, lymphocyte doubling time <6 months, and juvenile lymphadenopathy .

Chemotherapy

Including chlorambucil, fludarabine, glucocorticoids, etc.

2. Radiation therapy.

3. Immunotherapy

Such as interferon, anti-CD20 monoclonal antibody, anti-CD52 antibody and so on.

4. Hematopoietic stem cell transplantation.

Prognosis of chronic lymphocytic leukemia

Although chronic lymphocytic leukemia develops slowly, it is difficult to cure. Some patients can transform to other malignant lymphoproliferative diseases such as prolymphocytic leukemia, diffuse large B-cell lymphoma, Hodgkin's lymphoma, and acute lymphocytic. The median survival time of chronic lymphocytic leukemia is generally 35 to 63 months, and some patients have a survival time of more than 10 years.