Chronic Lymphocytic Leukemia (CLL)

Clinical Description 

Chronic Lymphocytic Leukemia (CLL) is a cancer of lymphocytes, a type of white blood cell that is normally part of the immune system. It is the most common leukemia in the Western world, with about 15,000 new cases of CLL diagnosed in the United States annually. It is estimated that some 100,000 people in the US are living with the disease. CLL is more common in people who are over the age of 60. 

Lymphocytes are a component of the normal immune system that helps fight infection. There are two principal kinds of lymphocytes, B cells and T cells, which function to make antibodies (B cells) and to regulate the immune system and directly eliminate infected or diseased cells (T cells). Both are initially produced in the bone marrow, T cells mature in the thymus, and both subsequently circulate in the blood and through the lymph nodes and spleen. In CLL patients, a single mature B or T lymphocyte becomes cancerous and begins to slowly divide and expand, which crowds out the normal diverse populations of these cells. The lymphocytes that are made also don’t work effectively. This can affect the function of the immune system, sometimes making people with CLL prone to certain infections. Because the immune system is unregulated, people with CLL can develop autoimmune disorders with destruction of the patient’s own platelets and red blood cells. If enough of these lymphocytes are made, they can crowd the bone marrow and affect the body’s ability to make red blood cells that carry hemoglobin (important for oxygen circulation) and platelets (important for control of bleeding). Lymphocytes can also fill the lymph nodes which can cause the lymph nodes to enlarge, as well as the liver and spleen. 

Symptoms of CLL

Many people with CLL have no symptoms and the diagnosis is made by an elevated lymphocyte count on a routine blood test. Sometimes patients may note one or more enlarged lymph nodes, which are usually painless. The disease can also cause recurrent fevers, chills and night sweats. If the hemoglobin is low due to autoimmune destruction of the red blood cells or from crowding in the bone marrow, fatigue can occur. If the platelet count is low due to autoimmune destruction of the platelets or from crowding in the bone marrow, bleeding and bruising can occur. 

Risk Factors of CLL

Generally, there are no known risk factors for CLL; however there can be a predisposition to CLL if several family members already have it. For reasons that are not understood, CLL is much less common in Asia and persons of Asian descent.

How CLL is Diagnosed

Frequently, CLL is found on routine blood work since most people with CLL may have no symptoms. If there are abnormalities on routine blood work, special testing is done to confirm the diagnosis. One of the tests used is flow cytometry to measure proteins that are expressed on the outside of the cell and are typical of CLL. In addition, FISH (fluorescence in-situ hybridization) is a test that can look at changes in the chromosome of the cancer cells. Certain abnormalities of the chromosomes can predict for a milder or more aggressive form of the disease, and may influence which treatment is chosen. A bone marrow biopsy is usually done to determine whether the marrow is involved and to get a more complete picture of the chromosomes at diagnosis. 
Each patient with CLL will have routine CAT scans, which may be necessary periodically, to measure enlarged lymph nodes as well as the liver and spleen which can also become enlarged.

Treatment Options for CLL at Tufts Medical Center

The goal of treatment of CLL is to minimize symptoms or complications of the disease; therefore, many people with CLL may never need treatment. Reasons to consider treatment of CLL include but are not limited to:

• If the immune system is severely affected causing frequent infections.
• If the red blood cells or platelets are decreased, causing fatigue or bleeding complications.
• If the lymph nodes or spleen are significantly enlarged.
• If the patient is having recurrent fevers, chills, night sweats or weight loss. 

Certain high risk features in CLL have been identified which can predict whether a patient will do worse and have an accelerated course. Those markers will be checked at disease presentation and during the course of the disease. Those patients may be candidates to undergo a bone marrow stem cell transplant early in the course of disease, before the leukemia has become resistant.

Treatment for CLL is usually in the form of chemotherapy. Two common chemotherapy regimens are fludarabine, cyclophosphamide and rituximab (FCR) or pentostatin, cyclophosphamide and rituximab (PCR). Alternatively, bendamustine with rituximab is now being used. Alemtuzumab is a monoclonal antibody which also offers a treatment option. If the CLL returns after different chemotherapy regimens have been tried, a bone marrow stem cell transplant or a clinical trial should be considered. Since CLL frequently is a disease seen in older patients, the reduced intensity preparative regimen for transplantation that was developed at Tufts is particularly suited to provide this therapy to older patients. A transplant is the only cure for CLL at that stage.

Tufts Medical Center also participates in a nationwide trial with a new monoclonal antibody in patients with advanced CLL. This antibody is unique in that it is smaller than the currently available antibodies and can penetrate lymph nodes much better.

Programs + Services

Hematologic Malignancies Program

Explore our blood cancer program and learn more about treatment options for hematologic malignancies including lymphoma and leukemia at Tufts Medical Center in Boston.

Doctors + Care Team

Andreas K. Klein, MD

Andreas K. Klein, MD

Title(s): Director, Hematologic Malignancies Program; Assistant Director, Bone Marrow and Hematopoietic Cell Transplant Program; Chair, Tufts Health Sciences Campus Institutional Review Boards; Associate Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-6227
Fax #: 617-636-8538

Lymphoma, myeloma, bone marrow transplantation (BMT), immune reconstitution after BMT

More Info

Kellie A. Sprague, MD

Kellie A. Sprague, MD

Title(s): Director, Bone Marrow and Stem Cell Transplant Program; Director, Adult Leukemia Program; Assistant Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-6227
Fax #: 617-636-8538

Bone marrow transplantation, acute and chronic leukemia, myelodysplastic syndromes, lymphoma, myeloma, myeloproliferative disorders

More Info

Kenneth B. Miller, MD

Kenneth B. Miller, MD

Title(s): Associate Chief, Division of Hematology/Oncology; Professor, Tufts University School of Medicine
Department(s): Medicine, Hematology/Oncology
Appt. Phone: 617-636-2600
Fax #: 866-322-3111

Acute myelogenous leukemia (AML), myelodysplastic syndrome (MDS), lymphoma, bone marrow and stem cell transplantation

More Info

Monika Pilichowska, MD, PhD

Monika Pilichowska, MD, PhD

Title(s): Director, Hematopathology and Hematology Laboratory; Associate Professor, Tufts University School of Medicine
Department(s): Pathology and Laboratory Medicine
Appt. Phone: 617-636-7216
Fax #: 617-636-7128

Hematology and hematopathology, flow cytometry, surgical pathology and cytology, renal pathology (medical renal disease)

More Info

Raymond L. Comenzo, MD

Raymond L. Comenzo, MD

Title(s): Director, Blood Bank and Stem Cell Processing Laboratory; Director, John C. Davis Myeloma and Amyloid Program; Professor, Tufts University School of Medicine
Department(s): Medicine, Pathology and Laboratory Medicine, Hematology/Oncology
Appt. Phone: 617-636-6454
Fax #: 617-636-3175

Myeloma, amyloidosis, stem cell transplant, transfusion medicine

More Info

Tufts Medical Center and Floating Hospital for Children have high quality care.

Quality + Safety

A world-class teaching hospital shouldn’t make you feel small.  At Tufts Medical Center the patient is at the center of everything that we do.  This means we’re committed to providing the highest quality of care in a safe, friendly environment.

Learn more
The City of Boston.

200 Years of Caring for the Community

Tufts Medical Center has been taking care of Boston and the surrounding community for more than 200 years.

Read about our enduring history