What Is CLL?

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What is chronic lymphocytic leukemia (CLL)? Dr. William Wierda, a world-renowned CLL expert from MD Anderson Cancer Center in Houston, defines the disease and explains its behavior in the body.

 

The Ask the Expert series is sponsored through an education grant to the Patient Empowerment Network from Pharmacyclics, Inc.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Jeff Folloder:

Let's start off with a basic question.  Just what is CLL?

Dr. Wierda:

Well, CLL is a malignancy.  It's a malignancy of cells of the immune system or B cells.  It's in terms of the B-cell malignancies it's categorized as a more indolentor slow-growing B-cell malignancy.  There are other more aggressive B-cell malignancies, but CLL is a malignancy of B cells that is relatively slow growing compared to the others.

It's is an interesting disease because there are other features that occur with the disease, such as increased risk for infection, increased risk for autoimmune processes that are—because the disease—that develop because the disease is there that is—that are unique features that be don't see in some of the other B-cell malignancies.  And it sort of gets at this issue of immune disregulation that's brought on by the CLL cells.

The CLL cells are malignant cells in that they continuously grow, and they have a longer than normal lifespan for B cells.  So, ultimately, what ends up happening is as the CLL cells grow they accumulate, and patients develop an elevated lymphocyte count in their blood.  The cells like to grow into lymph nodes, so patients will have enlarged lymph nodes over time or enlarging lymph nodes over time.

And patients—the disease grows in the bone marrow, so as a result, if the CLL cells are growing in the bone marrow, they crowd everything else out, and they don't allow the normal things that usually grow in the bone marrow to grow.  So, for example, patients' hemoglobin will decrease over time, because the cells that make the red blood cells in the marrow are crowded out and can't there.  Also, the platelet count will drop with time because the megakaryocytes, which are typically found in the bone marrow get crowded out and can't grow.

Those things improve when patients get on treatment and go into a remission, so things that we look for patients who are in remission, for example, are the lymphocyte count goes back to normal.  The lymph nodes go back to normal size which is—which is unmeasurable by physical exam, and the bone marrow clears out of the disease allowing the normal stuff to grow there and the effect, the ultimate effect is for the hemoglobin to go back up into the normal range and the platelet count to go back into the normal range. 

There are—there is a diversity in how the disease behaves between patients.  So some patients have disease that grows quicker than others.  Some patients has—have the—some patients have disease that doesn't grow, so we can see it, it's there. We can see that the lymphocyte count's elevated, they may or may not have lymph nodes that we can feel, but it doesn't change over time.  And we've tried to work on identifying parameters or prognostic factors that tell us which category patients might fall into, disease that's active, growing, that probably will need treatment versus patients who have disease that's more indolent, smoldering, not active and may not need to be treated ever.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on July 9, 2014