Chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is a type of cancer of the blood and bone marrow the spongy tissue inside bones where blood cells are made. The term "chronic" in chronic lymphocytic leukemia comes from the fact that it typically progresses more slowly than other types of leukemia. The term "lymphocytic" in chronic lymphocytic leukemia comes from the cells affected by the disease a group of white blood cells called lymphocytes, which help your body fight infection. Chronic lymphocytic leukemia most commonly affects older adults. Chronic lymphocytic leukemia treatments can help control the disease. Symptoms

Many people with chronic lymphocytic leukemia have no symptoms. Those who do develop signs and symptoms may experience:

Enlarged, but painless, lymph nodes Fatigue Fever Pain in the upper left portion of the abdomen, which may be caused by an enlarged spleen Night sweats Weight loss Frequent infections When to see a doctor Make an appointment with your doctor if you're concerned about any of your signs and symptoms. Causes Doctors aren't certain what starts the process that causes chronic lymphocytic leukemia. Doctors know that something happens in order to cause a genetic mutation in the DNA of blood-producing cells. This mutation causes the blood cells to produce abnormal, ineffective lymphocytes one type of white blood cell that helps your body fight infection. Beyond being ineffective, these abnormal lymphocytes continue to live and multiply, when normal lymphocytes would die. The abnormal lymphocytes accumulate in the blood and certain organs, where they cause complications. They may crowd healthy cells out of the bone marrow and interfere with normal blood cell production.

Doctors and researchers are working to understand the exact mechanism that causes chronic lymphocytic leukemia. Risk factors Factors that may increase the risk of chronic lymphocytic leukemia include:

Your age. Most people diagnosed with chronic lymphocytic leukemia are over 60. Your sex. Men are more likely than are women to develop chronic lymphocytic leukemia. Your race. Whites are more likely to develop chronic lymphocytic leukemia than are people of other races.

Family history of blood and bone marrow cancers. A family history of chronic lymphocytic leukemia or other blood and bone marrow cancers may increase your risk.

Exposure to chemicals. Certain herbicides and insecticides, including Agent Orange used during the Vietnam War, have been linked to an increased risk of chronic lymphocytic leukemia. Complications Chronic lymphocytic leukemia may cause complications such as:

Frequent infections. People with chronic lymphocytic leukemia may experience frequent infections. In most cases, these infections are common infections of the upper and lower respiratory tract. But sometimes more-serious infections can develop.

A switch to a more aggressive form of cancer. A small number of people with chronic lymphocytic leukemia may develop a more aggressive form of cancer called diffuse large B-cell lymphoma. Doctors sometimes refer to this switch as Richter's syndrome.

Increased risk of other cancers. People with chronic lymphocytic leukemia have an increased risk of other types of cancer, including skin cancer, such as melanoma, and cancers of the lung and the digestive tract.

Immune system problems. A small number of people with chronic lymphocytic leukemia may develop an immune system problem that causes the disease-fighting cells of the immune system to mistakenly attack the red blood cells or the platelets. Tests and diagnosis Blood tests Tests and procedures used to diagnose chronic lymphocytic leukemia include blood tests designed to:

Count the number of cells in a blood sample. A complete blood count may be used to count the number of lymphocytes in a blood sample. A high number of B cells, one type of lymphocyte, may indicate chronic lymphocytic leukemia.

Determine the type of lymphocytes involved. A test called flow cytometry or immunophenotyping helps determine whether an increased number of lymphocytes is due to chronic lymphocytic leukemia, a different blood disorder or your body's reaction to another process, such as infection. If chronic lymphocytic leukemia is present, flow cytometry may also help analyze the leukemia cells for characteristics that help predict how aggressive the cells are.

Analyze lymphocytes for genetic abnormalities. A test called fluorescence in situ hybridization (FISH) examines the chromosomes inside the abnormal lymphocytes to look for abnormalities. Doctors sometimes use this information to determine your prognosis and help choose a treatment. Other tests In some cases your doctor may order additional tests and procedures to aid in diagnosis, such as:

Bone marrow biopsy and aspiration Computerized tomography Staging Once a diagnosis is confirmed, your doctor determines the extent (stage) of your chronic lymphocytic leukemia. Two different staging systems are used. Each assigns a stage early, intermediate or advanced that indicates the progression of a person's chronic lymphocytic leukemia. These levels are used to determine your treatment options. In general, people with early-stage disease don't require immediate treatment. Those with intermediate-stage disease and advanced-stage disease may be given the option to begin treatment right away. Treatments and drugs Your treatment options for chronic lymphocytic leukemia depend on several factors, such as the stage of your cancer, whether you're experiencing signs and symptoms, your overall health, and your preferences. Treatment may not be necessary in early stages People with early-stage chronic lymphocytic leukemia typically don't receive treatment, though clinical trials are evaluating whether early treatment may be helpful. Studies have shown that early treatment doesn't extend lives for people with early-stage chronic lymphocytic leukemia. Rather than put you through the potential side effects and complications of treatment before you need it, doctors carefully monitor your condition and reserve treatment for when your leukemia progresses. Doctors call this watchful waiting. Your doctor will plan a checkup schedule for you. You may meet with your doctor and have your blood tested every few months to monitor your condition.

Treatments for intermediate and advanced stages If your doctor determines your chronic lymphocytic leukemia is progressing or is in the intermediate or advanced stages, your treatment options may include:

Chemotherapy. Chemotherapy is a drug treatment that kills cancer cells. Chemotherapy treatments can be given through a vein in your arm or taken in pill form. Depending on your situation, your doctor may use a single chemotherapy drug or you may receive a combination of drugs. Side effects depend on what chemotherapy drugs are used. Common side effects include fatigue, low blood cell counts and a risk of frequent infections.

Targeted drug therapy. Targeted drugs are designed to take advantage of the specific vulnerabilities of your cancer cells. Chronic lymphocytic leukemia cells have a variety of proteins on their surfaces. Targeted therapy drugs are designed to bind to a specific protein as a way to target and kill leukemia cells. Targeted therapy drugs used in treating chronic lymphocytic leukemia include rituximab (Rituxan), alemtuzumab (Campath) and ofatumumab (Arzerra). Side effects of these drugs include fever, chills and infections.

Bone marrow stem cell transplant. Bone marrow stem cell transplants use strong chemotherapy drugs to kill the stem cells in your bone marrow that are creating diseased lymphocytes. Then healthy adult blood stem cells from a donor are infused into your blood, where they travel to your bone marrow and begin making healthy blood cells. A reduced intensity, or "mini," bone marrow stem cell transplant is similar to a standard stem cell transplant, but it uses lower doses of chemotherapy drugs. Bone marrow stem cells may be a treatment option for people who aren't helped by other treatments or for certain people with very aggressive chronic lymphocytic leukemia.

LEUKEMIA

Pathophysiology:

When Leukemias progress, they can cause a

Leukemia is a cancerous disorder of the

blood vessels. Malignant exacerbation in the number of Leukocytes (WBC), usually at an immature stage, in the bone marrow, causing: Anemia Leukopenia Thrombocytopenia Decline in immunity

Four Major Types of Leukemia:

rise or decline in the number of blood cells. Even though the total number of blood cells may be elevated, in most instances, the count of normal blood cells is reduced. This is due to overproduction of the leukemic cells that result in overpopulation of the bone marrow and suppression of normal blood cell production. In most instances, the underlying problem is an abnormality in maturation and growth of normal blood cells which leads to accumulation of abnormal, immature and dysfunctional cells in the blood, the leukemia cells.

ACUTE LYMPHOCYTIC LEULEMIA (ALL)

- mostly lymphoblasts present in bone marrow - age of onset is less than 15 years RISK FACTORS:

Genetic Viral Immunological and environmental factors Exposure to radiation, chemicals, and
medications

ACUTE MYELOGENOUS LEUKEMIA (AML)

- mostly myeloblasts present in bone marrow - age of onset is between 15 and 39 years

MANIFESTATIONS:

Anorexia, fatigue, weakness, weight loss Anemia Bleeding (nosebleed, gum bleeding, rectal
bleeding, hematuria, increased mentrual flow) Petechiae Prolonged bleeding after minor abrasions or lacerations Elevated temperature Lymphadenopathy and splenomegaly Palpitations, tachycardia, orthostatic hypotension Pallor and dyspnea on exertion Headache Bone pain and joint swelling Normal, elevated, or reduced WBC count Decreased hemoglobin and hematocrit levels Decreased platelet count Positive bone marrow biopsy identifying leukemic blast phase cells

CHRONIC MYELOGENOUS LEUKEMIA (CML)

- mostly granulocytes present in bone marrow - age of onset is after 50 years

CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)

- mostly lymphocytes present in bone marrow - age of onset is after 50 years

Acute Leukemia refers to Leukemia which, if

left untreated, can cause fatal complications in a very short period of time. Chronic Leukemias, on the other hand, if left untreated in some cases may not cause any problems at all even for years.

MANAGEMENT:

(A) Infection

Instruct the client to avoid activities that

expose the client to infection Instruct clients that neither they nor their household contacts should receive immunization with the live virus (B) Bleeding

Initiate protective isolation procedures Ensure frequent and thorough handwashing Ensure that everyone entering the room is
wearing a mask Use strict aseptic technique Keep supplies for the client separate from supplies for other clients; keep frequently used equipment in the room for the clients use only Limit the number of caregivers entering the clients room Maintain the client in a private room Place the client in a room with high-efficiency particulate air (HEPA) filtration or laminar air flow system if possible Be sure that the clients room is cleansed daily Reduce exposure to environmental organisms by eliminating raw fruits and vegetables from the diet and fresh flowers from the clients room and by not leaving standing water in the clients room. Assist client to perform oral hygiene frequently. Assist the client with daily bathing, using an antimicrobial soap. Initiate a bowel program to prevent constipation and prevent rectal trauma. Assess the urine for color and cloudiness Avoid invasive procedures such as injections, rectal temperatures, and urinary catheterization Change wound dressings daily, and inspect the wounds for redness, swelling, or drainage Assess skin and oral mucous membranes for signs of infection Auscultate lung sounds, and encourage the client to cough and deep breathe Monitor temperature, pulse, and blood pressure Monitor WBC and neutrophil counts Notify the physician if signs of infection are present, and prepare to obtain specimens for culture of open lesions, urine, and sputum Administer prescribed antibiotic, antifungal, and antiviral medication Instruct the client to avoid crowds and those with infections Instruct the client about a low-bacteria diet and to avoid drinking water that has been standing for longer than 15 minutes

During the nadir, the platelet count may be

extremely low, less than 10,000/mm3 50,000/mm3 risk for bleeding 20,000/mm3 risk for spontaneous bleeding