Selina M. Luger, MD
Last Modified: September 22, 2002
Dear OncoLink "Ask The Experts,"
My partner has CLL and is 40 years old. He was diagnosed 2 years ago and his white blood cell count has doubled each year for the past two years. His nodes, liver and spleen are enlarged and he is now on chemotherapy. Is CLL related to lymphoma(s)? He does not suffer from frequent infection or fevers will this risk increase as time goes on? His platelet and red blood cell counts are low; will the chemo help these improve?
Selina M. Luger, MD, Director of the Leukemia Program and Assistant Professor of Medicine at the University of Pennsylvania, responds:
CLL (chronic lymphocytic leukemia) is a cancerous disease of the lymphoid system and is related to the lymphomas. It is hard to tell the difference between CLL and lymphoma if the lymph nodes are large and the white blood count is not exceedingly high (a patient with CLL can have enlarged lymph nodes and a patient with lymphoma can have excess lymphoma cells in the blood). However, the treatment is the same regardless of which disease process is occurring.
Patients with CLL typically present with elevated white blood counts, and most of those white blood cells are lymphocytes. In its earliest stages, only the white blood cells are increased, and the bone marrow is filled with these same lymphocytes (a bone marrow test is not necessary but if one were to look, that is what one would find). As the disease advances, the lymph nodes can become involved. The liver and spleen any enlarge and the normal hemoglobin and platelet count may decrease. Although the white blood count itself is not usually a reason for treatment, the other factors often require initiation of therapy. Hopefully with therapy these issues will resolve.
There are several reasons that a patient with CLL may be susceptible to infections--the disease itself makes patients more susceptible. There is no real way to test if any individual patient will be more likely to get more infections. Also the treatments themselves can make patients more susceptible to infections.
The choice of treatment often depends on the reason that treatment is being started. Often a drug called fludarabine is used in the initial therapy. Hopefully, your partner will have an excellent response to therapy. At the age of 40, there are quite a few new treatments that are available and can be considered at a later date if necessary.