Disease progression of chronic lymphocytic leukemia

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 tiredness
  • fever for more than 2 weeks without any signs of infection
  • night sweats for longer than 1 month
  • bone marrow failure that gets worse and lower numbers of healthy red blood cells (called anemia) or platelets (called thrombocytopenia)
  • anemia and thrombocytopenia that does not respond to steroids
  • a spleen that is larger than normal and may be causing symptoms such as abdominal discomfort or a feeling of fullness
  • more areas of enlarged lymph nodes
  • an enlarged liver
  • 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’s syndrome, or a Richter transformation, and if this happens, it usually develops into a diffuse large B-cell lymphoma (DLBCL), which is treated like a lymphoma.

Expert review and references

  • American Cancer Society. Leukemia - Chronic Lymphocytic. Atlanta, GA: American Cancer Society; 2013: http://www.cancer.org/acs/groups/cid/documents/webcontent/003111-pdf.pdf.
  • Borthakur G, O'Brien S . Treatment of chronic lymphocytic leukemia and related disorders. Wiernik PH, Goldman JM, Dutcher JP & Kyle RA (eds.). Neoplastic Diseases of the Blood. 5th ed. Springer; 2013: 9: pp. 121-119.
  • Mir Muhammad A . Chronic lymphocytic leukemia treatment & management. eMedicine.Medscape.com. WebMD LLC; 2014.
  • National Cancer Institute. Chronic lymphocytic leukemia Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014.
  • Wierda WG, O'Brien S . Chronic lymphocytic leukemia. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014: 134: pp. 1973-1987.