Chronic Lymphocytic Leukemia (CLL) is one of the most common types of leukemia that occurs in adults. It is a form of cancer that begins in cells that develop into white blood cells known as lymphocytes in the bone marrow. The cancer starts in the bone marrow and then goes onto affect the blood. Most people are usually surprised to receive a diagnosis of chronic lymphocytic leukemia since the disease usually does not present with any physical symptoms. Here’s what to expect during chronic lymphocytic leukemia progression.
Overview of Chronic Lymphocytic Leukemia
Chronic lymphocytic leukemia is the most common form of leukemia in adults.(1,2) The cancer begins in the white blood cells known as lymphocytes that are present in the bone marrow. The leukemia cells begin in the bone marrow and then go into the bloodstream. The term chronic in chronic lymphocytic leukemia means that the disease progresses in a slower manner than other forms of leukemia.(3,4) Lymphocytic refers to the cells that are affected by the disease, which are a type of white blood cells known as lymphocytes, that help the body fight against infection.(5)
Most people who are diagnosed with this condition are taken by surprise as it usually does not present with physical symptoms. While in the beginning, your doctor may recommend delaying treatment until you start experiencing any signs of the cancer progressing. Chronic lymphocytic leukemia is a slowly progressing cancer, so it may take several years before you start experiencing the symptoms. In the meantime, though, you will continue to undergo regular checkups to check your blood cell counts. When the cancer progresses to a more advanced stage, you may start experiencing the symptoms of chronic lymphocytic leukemia. The symptoms will be mild to moderate at the start and gradually get worse as the abnormal cells start building up and spreading throughout the body.(6)
Signs That Show Chronic Lymphocytic Leukemia Is Progressing
It is important to know what you should expect if your cancer is progressing so that you can let your doctor know at the earliest, and your treatment can begin at the earliest. Here are the symptoms that indicate your chronic lymphocytic leukemia is progressing:
- Weight Loss: Experiencing unexplained weight loss of over 10 percent of your body weight during a course of six months or more could be an indication that your cancer is progressing. This shows that you are losing weight even though you are not trying to diet or actively lose weight.(7)
- Fever and Night Sweats: As the cancer advances, you may wake up in the night sweating profusely or drenched in sweat. You may also experience an unexplained fever with temperatures over 100.4oF (38oC) that may continue to persist for weeks without there being any indication of an infection.(8)
- Extreme Fatigue: Feeling extremely tired, along with shortness of breath while going about your normal daily activities, is another sign that your cancer has progressed. This happens because of the reduced number of healthy red blood cells left in the body and the increased number of cancer cells accumulated in the body by this stage.(9)
- Swollen Lymph Nodes: The lymph nodes are a major part of the body’s immune system and are mostly located in the groin, neck, and near the armpits. As the cancer advances, the high number of abnormal cancer cells may accumulate in the lymph nodes, causing them to become enlarged or swell up. Swollen lymph nodes will feel like there is a lump present under your skin.
- Regular Infections: People who have chronic lymphocytic leukemia already have a weakened immune system and are more prone to getting infections. This is because there are not enough healthy white blood cells that can effectively fight off the infection.
- Enlarged Spleen: Your spleen is responsible for filtering out your blood as a part of your immune system. As the cancer cells start building up in the bloodstream, the spleen starts to become swollen. An enlarged spleen can cause you to feel fullness in the stomach or abdomen. It can also cause abdominal pain and discomfort.
- Abnormal Lab Tests: Since you will need to undergo regular check-ups, you may find that your laboratory tests may start showing a lower number of platelets or red blood cells. A low red blood cell count is a condition known as anemia, and low platelet count is known as thrombocytopenia.(10) Additionally, your lab reports may also show that you have an increased number of lymphocytes, which is a type of white blood cells. The number of lymphocytes may increase by over 50 percent in a span of just two months, or it may double in less than six months.(11)
Rate of Progression of Chronic Lymphocytic Leukemia
Every case of chronic lymphocytic leukemia is different, and every person experiences the cancer in a different manner. This is why it is difficult to predict when and if your cancer is going to advance. While some people experience fast progression, others can go on for years without experiencing any advancement or any new symptoms.
However, it has been observed that people who get diagnosed at an advanced stage of chronic lymphocytic leukemia are more likely to progress at a faster pace.
According to the Rai system of staging and diagnosing, stage 0 of chronic lymphocytic leukemia is considered to be at low risk.(12) Stages 1 and 2 are known as intermediate risk, while stages 3 to 4 are considered to be a high risk of progression. Your doctor will inform you about your cancer stage and disease progression based on your lab reports.
Can Chronic Lymphocytic Leukemia Turn Into Lymphoma?
In some rare cases, chronic lymphocytic leukemia can progress to develop into high-grade non-Hodgkin’s lymphoma. This is a complication of chronic lymphocytic leukemia that is known as Richter’s syndrome, or Richter transformation.(13)
It is expected that nearly five percent of all people with small lymphocytic lymphoma (SLL) or chronic lymphocytic leukemia go on to develop Richter’s syndrome as their disease progresses.(14)
When the cancer develops into Richter’s syndrome, people with chronic lymphocytic leukemia can experience a dramatic and sudden aggravation in their symptoms, including:
- Unexplained weight loss
- Increased fatigue
- Shortness of breath
- Swelling of the lymph nodes in the abdomen, groin, the neck, or axilla
- Excessive bleeding and bruising due to low platelet count
Can Cancer Progression be Slowed Down?
While it may not always be possible to slow down the progression of chronic lymphocytic leukemia, this cancer itself is a slow-progressing cancer but, seeking early treatment for this condition has not shown many benefits.(15)
However, according to results from early phase I and II clinical trials, an active ingredient present in green tea known as epigallocatechin 3 gallate (EGCG) may help slow down progression in cases where the disease is still in the early stages.(16)
Research has also found that having high levels of vitamin D in the blood at the time of diagnosis is lined with a slower rate of disease progression.(17) However, more research on the potential benefits of taking vitamin D supplements for slowing down the progression of chronic lymphocytic leukemia is still needed.
At the same time, Richter’s syndrome is challenging to prevent, and the exact causes of why chronic lymphocytic leukemia develops into Richter’s syndrome in some people remains unclear. One of the most common risk factors for Richter’s syndrome is inherited genetic characteristics or genetic mutations that cannot be prevented.
If you have been diagnosed at an early stage of chronic lymphocytic leukemia, following up with your doctor regularly and getting regular lab tests done to monitor the status of your cancer can help. If you start experiencing signs of cancer progression, including unexplained weight loss, fever, swollen lymph nodes, unexplained fatigue, and night sweats, you should immediately let your oncologist or hematologist know so that any necessary treatment could be started right away.
- Chiorazzi, N., Rai, K.R. and Ferrarini, M., 2005. Chronic lymphocytic leukemia. New England Journal of Medicine, 352(8), pp.804-815.
- Rozman, C. and Montserrat, E., 1995. Chronic lymphocytic leukemia. New England Journal of Medicine, 333(16), pp.1052-1057.
- Keating, M.J., 1999, October. Chronic lymphocytic leukemia. In Seminars in oncology (Vol. 26, No. 5 Suppl 14, pp. 107-114).
- Rai, K.R., Sawitsky, A., Cronkite, E.P., Chanana, A.D., Levy, R.N. and Pasternack, B.S., 1975. Clinical staging of chronic lymphocytic leukemia. Dameshek, W., 1967. Chronic lymphocytic leukemia—an accumulative disease of immunologically incompetent lymphocytes. Blood, 29(4), pp.566-584.
- Kemp, J.D., Stenn, K.S., Arons, M. and Fischer, J., 1978. Metastasizing atypical fibroxanthoma: coexistence with chronic lymphocytic leukemia. Archives of Dermatology, 114(10), pp.1533-1535.
- Rundles, R.W. and Moore, J.O., 1978. Chronic lymphocytic leukemia. Cancer, 42(S2), pp.941-945.
- Cunha, B.A., Mohan, S. and Parchuri, S., 2005. Fever of unknown origin: Chronic lymphatic leukemia versus lymphoma (Richter’s transformation). Heart & Lung, 34(6), pp.437-441.
- Alvarez‐Mori, M., Casas, J., Laguna, R., Jordá, J. and Durantez, A., 1987. Clinical signification of natural killer activity in B‐cell chronic lymphocytic leukemia. European journal of haematology, 38(3), pp.268-273.
- EBBE, S., WITTELS, B. and DAMESHEK, W., 1962. Autoimmune thrombocytopenic purpura (” ITP” type) with chronic lymphocytic leukemia. Blood, 19(1), pp.23-37.
- Molica, S. and Alberti, A., 1987. Prognostic value of the lymphocyte doubling time in chronic lymphocytic leukemia. Cancer, 60(11), pp.2712-2716.
- Cancer.org. 2020. Chronic Lymphocytic Leukemia Stages. [online] Available at: <https://www.cancer.org/cancer/chronic-lymphocytic-leukemia/detection-diagnosis-staging/staging.html> [Accessed 26 September 2020].
- Foucar, K. and Rydell, R.E., 1980. Richter’s syndrome in chronic lymphocytic leukemia. Cancer, 46(1), pp.118-134.
- Krause, J.R., Drinkard, L.C. and Keglovits, L.C., 2013, January. Hodgkin lymphoma transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma. In Baylor University Medical Center Proceedings (Vol. 26, No. 1, pp. 16-18). Taylor & Francis.
- Lls.org. 2020. Watch And Wait | Leukemia And Lymphoma Society. [online] Available at: <https://www.lls.org/leukemia/chronic-lymphocytic-leukemia/treatment/watch-and-wait> [Accessed 26 September 2020].
- Shanafelt, T.D., Call, T., Zent, C.S., LaPlant, B., Leis, J.F., Bowen, D., Roos, M., Jelinek, D.F., Erlichman, C. and Kay, N.E., 2010. Phase II trial of daily, oral green tea extract in patients with asymptomatic, Rai stage 0-II chronic lymphocytic leukemia (CLL). Journal of Clinical Oncology, 28(15_suppl), pp.6522-6522.
- Molica, S., Digiesi, G., Antenucci, A., Levato, L., Mirabelli, R., Molica, M., Gentile, M., Giannarelli, D., Sperduti, I., Morabito, F. and Conti, L., 2012. Vitamin D insufficiency predicts time to first treatment (TFT) in early chronic lymphocytic leukemia (CLL). Leukemia research, 36(4), pp.443-447.