Disease progression of chronic lymphocytic leukemia

Last medical review:

Cancer cells can spread from where they start to other parts of the body. Unlike other types of cancer, leukemia does not usually form solid tumours in other organs in the body. Leukemia is a cancer of the blood-forming tissue in the bone marrow, and it can develop wherever the blood travels. As a result, chronic lymphocytic leukemia (CLL) is often widespread when it is found.

Understanding how a type of cancer usually progresses helps your healthcare team plan your treatment and future care. Leukemia cells usually collect in the lymph nodes, spleen and liver. The buildup of leukemia cells in these organs affects them so they don’t work normally.

Symptoms of the progression of CLL include:

  • more than 10% weight loss in 6 months
  • extreme fatigue
  • fever for more than 2 weeks without any signs of infection
  • night sweats for longer than 1 month
  • an increasing number of CLL cells in the bone marrow that make the bone marrow not work properly, leading to anemia (lower numbers of healthy red blood cells) or thrombocytopenia (lower number of platelets in the blood)
  • a spleen that is larger than normal and may be causing symptoms such as discomfort or a feeling of fullness
  • more areas of enlarged lymph nodes in the body that cause discomfort
  • an enlarged liver that causes discomfort
  • the number of lymphocytes increases by more than 50% in 2 months or doubles in less than 6 months (rapid doubling time)

In rare cases, CLL develops into a high-grade non-Hodgkin lymphoma. This condition is called Richter transformation, and if this happens, it usually develops into a diffuse large B-cell lymphoma, which is treated like a lymphoma.

Expert review and references

  • Versha Banerji, MD, FRCPC
  • Guideline Resource Unit. Chronic Lymphocytic Leukemia. Edmonton: Alberta Health Services; 2021: https://www.albertahealthservices.ca/.
  • International CLL-IPI working group. An international prognostic index for patients with chronic lymphocytic leukaemia (CLL-IPI): a meta-analysis of individual patient data. Lancet Oncology. 2016: 17(6):779–790.
  • Owen C, Banerji V, Johnson N, et al. Canadian evidence-based guideline for frontline treatment of chronic lymphocytic leukemia: 2022 update. Leukemia Research. 2023: 125:107016.
  • Wierda WG, O'Brien SM. Chronic lymphocytic leukemias. DeVita VT Jr., Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. 11th ed. Philadelphia, PA: Wolters Kluwer; 2019: Kindle version, ch 105, https://read.amazon.ca/?asin=B0777JYQQC&language=en-CA.

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