Hematologic Malignancies Program

Chronic Lymphocytic Leukemia

What Is Chronic Lymphocytic Leukemia? | Symptoms | Stages and Treatments | About the Clinical Trials | Greenebaum Cancer Center

Stages and Treatments

If a person is diagnosed with chronic lymphocytic leukemia, the doctor will order more tests to find out if leukemia cells have spread to other parts of the body. This process is called staging. A doctor needs to know the stage of the disease in order to plan treatment.

The following stages are used to describe chronic lymphocytic leukemia:

Stage 0: There are too many lymphocytes in the blood, but there are usually no other symptoms of leukemia. Lymph nodes and the spleen and liver are not swollen and the number of red blood cells and platelets is normal. Treatment may not be needed or chemotherapy may be given. A doctor will follow the patient closely so treatment can be started if the leukemia gets worse.

Stage I: There are too many lymphocytes in the blood and the lymph nodes are swollen. The spleen and liver are not swollen and the number of blood cells and platelets is normal. Treatment may be one of the following:

Stage II: There are too many lymphocytes in the blood and lymph nodes and the liver and spleen are swollen. Treatment may be one of the following:

Stage III: There are too many lymphocytes in the blood and there are too few red blood cells (anemia). Lymph nodes and the liver or spleen may be swollen. Treatment may be one of the following:

Stage IV: There are too many lymphocytes in the blood and too few platelets, which make it hard for the blood to clot. The lymph nodes, liver, or spleen may be swollen and there may be too few red blood cells (anemia). Treatment may be one of the following:

Refractory: Refractory means that the leukemia does not respond to treatment. Treatment depends on many factors. Patients may wish to consider entering a clinical trial of new chemotherapy drugs and bone marrow transplantation.

About the Treatments and Side Effects

There are three primary treatments for patients with chronic lymphocytic leukemia:

  1. chemotherapy
  2. radiation therapy
  3. treatment for complications of leukemia (such as infection)

Biological therapy and stem cell transplantation are being tested in clinical trials. In rare cases, the doctor may perform surgery to remove the spleen (splenectomy).

Side effects can occur with cancer treatments because healthy cells are often damaged along with cancer cells. The type and extent of these side effects vary depending on the particular treatment involved, its duration, and its dose.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Some anticancer drugs are injected into a vein (IV) or muscle; some are given by mouth; some are injected into the skin. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles: a treatment period is followed by a recovery period, then another treatment period, and so on.

Chemotherapy drugs generally target rapidly dividing cancer cells. However, other cells that also divide rapidly include blood cells, cells that line the digestive tract, and cells in hair follicles. Unfortunately, these healthy cells may also be impacted by the chemotherapy drugs, resulting in side effects such as infections, tiredness, temporary hair loss, mouth sores, and other symptoms. Not all chemotherapy patients develop all of these symptoms, and they usually go away during the recovery period or after treatment stops. Medicines and other treatments are available to control or minimize many of these symptoms.

Radiation therapy

Radiation is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation for chronic lymphocytic leukemia usually comes from a machine outside the body (external radiation therapy). The most common side effects of radiation therapy are tiredness, skin reactions in the treated areas (such as a rash or redness), and loss of appetite. Radiation therapy may also cause a decrease in the number of white blood cells that help protect the body against infection. Most of these side effects can be treated or controlled and in most cases they are not permanent.

Treatment of infections

Because infection often occurs in patients with chronic lymphocytic leukemia, a special substance called immunoglobulin, which contains antibodies, may be given to prevent infection.

Biological therapy

Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.

Stem cell transplantation

Stem cell transplantation is a treatment in which a patient's diseased bone marrow is replaced with healthy stem cells to repopulate the marrow. There are two main types of transplants:

Allogeneic transplant: A transplant using marrow from a relative or person not related to the patient is called an allogeneic transplant. Allogeneic transplants may be done using either a standard high-dose therapy or a less toxic, nonablative, immunosuppressive therapy.

In the standard high-dose therapy approach, all of the bone marrow in the body is destroyed with high doses of chemotherapy with or without radiation therapy. Healthy marrow or blood stem cells are then taken from another person (a donor) whose tissue is the same or almost the same as that of the patient. The donor may be a twin (the best match), a brother or sister, or a person who is not related. The healthy stem cells from the donor are then transferred to the patient through a needle in the vein, and the new marrow replaces the original marrow that was destroyed.

In a nonmyeloablative transplant, the goal is not to destroy the patient's marrow but to allow for the donor cells to take hold or "engraft." In this type of transplant, less intensive medications are used and the marrow is not completely destroyed prior to the transplant.

Autologous transplant: Another type of bone marrow transplant, called an autologous bone marrow transplant, is being studied in clinical trials. In this type of transplant, blood stem cells are taken from the patient after treatment with drugs to kill cancer cells. The stem cells that were taken from the patient are then frozen and stored. Next, high-dose chemotherapy is given to the patient with or without radiation therapy to destroy the remaining leukemia cells. The frozen stem cells are then thawed and given back to the patient through a needle in a vein to repopulate the marrow and make blood cells.

A greater chance for recovery occurs in hospitals that do more than five stem cell transplantations a year.


This page was last updated on: March 3, 2008.