Leukemia, Chronic Lymphocytic
A generalized, progressive disease, chronic lymphocytic leukemia is marked by the uncontrollable spread of abnormal, small lymphocytes in lymphoid tissue, blood, and bone marrow. When these cells infiltrate bone marrow, lymphoid tissue, and organ systems, clinical signs begin to appear.
This disease occurs most commonly in elderly people; nearly all those afflicted are males older than age 50. According to the American Cancer Society, chronic lymphocytic leukemia accounts for almost one-third of all new leukemia cases annually.
Chronic lymphocytic leukemia is the most benign and the most slowly progressive form of leukemia. However, the prognosis is poor if anemia, thrombocytopenia, neutropenia, bulky lymphadenopathy, and severe lymphocytosis develop. Gross bone marrow replacement by abnormal lymphocytes is the most common cause of death, usually within 4 to 5 years of diagnosis.
Causes
Although the cause of the disease is unknown, researchers suspect hereditary factors because a higher incidence has been recorded within families. Undefined chromosomal abnormalities and certain immunologic defects, such as ataxia-telangiectasia or acquired agammaglobulinemia, are also suspected. The disease doesn’t seem to result from radiation exposure.
Complications
The most common complication is infection, which can be fatal. In the end stage of the disease, possible complications include anemia, progressive splenomegaly, leukemic cell replacement of the bone marrow, and profound hypogammaglobulinemia, which usually terminates with fatal septicemia.
Assessment
In the early stages of the disease, the patient usually complains of fatigue, malaise, fever, weight loss, and frequent infections.
Inspection may reveal macular or nodular eruptions, evidence of skin infiltration. On palpation, you may note enlargement of the lymph nodes, liver, and spleen, along with bone tenderness and edema from lymph node obstruction.
As the disease progresses, you may note anemia, pallor, weakness, dyspnea, tachycardia, palpitations, bleeding, and infection from bone marrow involvement. You may also see signs of opportunistic fungal, viral, or bacterial infections, which commonly occur in late stages of the disease.
Diagnostic tests
Typically, chronic lymphocytic leukemia is an incidental finding during a routine blood test that reveals numerous abnormal lymphocytes. In the early stages, the patient has a mildly but persistently elevated white blood cell (WBC) count. Granulocytopenia is the rule, although the WBC count climbs as the disease progresses.
Blood studies also reveal a hemoglobin (Hb) count under 11 g/dl, hypogammaglobulinemia, and depressed serum globulin levels. Other common developments include neutropenia (less than 1,500/ mm3), lymphocytosis (more than 10,000/mm3), and thrombocytopenia (less than 150,000/mm3).
Bone marrow aspiration and biopsy show lymphocytic invasion. A computed tomography scan identifies affected organs.
Treatment
Systemic chemotherapy includes alkylating agents, usually chlorambucil orcyclophosphamide, and sometimes corticosteroids (prednisone) when autoimmune hemolytic anemia or thrombocytopenia occurs.
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