Leukemia investigation

Chronic Lymphocytic Leukemia

Printing of this publication is made possible by an education grant from Berlex Laboratories.

Introduction

This booklet provides information about chronic lymphocytic leukemia for patients

and their families. A glossary at the end of the booklet may help the reader under-

stand technical terms. We hope this information is of assistance. Comments as tothe clarity of the information provided or the omission of information that would

have been helpful are welcome.

Each year, about 8,100 persons in the United States learn that they have chronic

lymphocytic leukemia. The disease also may be referred to as chronic lymphoid

leukemia or as CLL. Before describing the disease and its management further, a

brief description of normalblood and marrow is provided for background.

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Table of Contents

Normal Blood and Marrow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 Leukemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Chronic Lymphocytic Leukemia . . . . . . . . . . . . . . . . . . . . . . . . . .5 Causes and Risk Factors . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .6 Symptoms and Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7 Disease Course and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Other Ancillary Treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12Complications and Their Treatment . . . . . . . . . . . . . . . . . . . . .12 Other Related Lymphocytic Leukemias . . . . . . . . . . . . . . . . . . .14 Lymphoma versus Lymphocytic Leukemia . . . . . . . . . . . . . . .17 Social and Emotional Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . .18 The Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19Glossary* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Further Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38

*Words in the glossary are italicized the first time that they appear in the text.

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Normal Blood and Marrow

Blood is composed of plasma and cells suspended in plasma. The plasma is largelymade up of water in which are dissolved many chemicals. These chemicals include proteins (e.g., albumin), hormones (e.g., thyroid hormone), minerals (e.g., iron), vitamins (e.g., folic acid), and antibodies, including those we develop from our immunizations (e.g., poliovirus antibodies). The cells include red cells, platelets, neutrophils, eosinophils, basophils, monocytes, and lymphocytes. Thered cells make up half the volume of the blood. They are filled with hemoglobin, the protein that picks up oxygen in the lungs and delivers oxygen to the tissues. The platelets are small cell fragments (one-tenth the size of red cells) that help stop bleeding if one is injured. For example, when one has a cut, the blood vessels that carry blood are torn open. Platelets stick to the torn surface ofthe vessel, clump together, and plug up the bleeding site. The vessel wall then heals at the site of the clot and returns to its normal state. The neutrophils and monocytes are white blood cells. They are phagocytes (or eating-cells) because they can ingest bacteria or fungi and kill them. Unlike the red cells and platelets, the white cells leave the blood and move into the tissues where they caningest invading bacteria or fungi and help cure an infection. Eosinophils and basophils are two additional types of white cells that participate in allergic responses. Most lymphocytes, another type of white blood cell, are in the lymph nodes, the spleen, and lymphatic channels, but some enter the blood. There are three major types of lymphocytes: T cells, B cells, and natural killer (NK) cells....