Overview
Diagnosis and tests
Diagnosis of chronic lymphocytic leukemia often begins with a physical exam. The exam checks for swollen lymph nodes in the neck, underarms, and groin, and an enlarged spleen. Other tests and procedures include blood tests, imaging tests, and taking a sample of tissue for lab testing.
Blood tests
Blood tests play an important role in diagnosing chronic lymphocytic leukemia.
A complete blood count measures the number of each type of cell in the blood. A high number of lymphocytes, especially B cells, may indicate chronic lymphocytic leukemia.
A peripheral blood smear shows how the cells look under a microscope. In chronic lymphocytic leukemia, there are often many small, round lymphocytes known as smudge cells.
Flow cytometry is used to identify proteins or markers on the surface of leukemia cells. These markers confirm the diagnosis and help predict how aggressive the disease might be.
Genetic and molecular testing looks for changes in the DNA of the cancer cells. The results help guide treatment and provide information about prognosis.
Other diagnostic procedures
Your healthcare team may recommend additional tests such as a bone marrow biopsy and aspiration. In this procedure, a sample of bone marrow is taken to check for abnormal cells and evaluate how well the bone marrow is working.
Imaging tests, such as CT or PET scans, may be used to look for enlarged lymph nodes or organs. Imaging also helps plan treatment and monitor how the disease responds to therapy.
Treatment
Treatment for chronic lymphocytic leukemia depends on whether symptoms are present, how advanced the cancer is, how fast it is growing, and your overall health.
Watch and wait
If the disease is not causing symptoms, you may not need treatment right away. Regular checkups every few months allow your healthcare team to monitor changes in blood counts or lymph node size.
Targeted therapy
Targeted therapy uses medicines that block specific proteins in leukemia cells, causing them to die. It is often used as the first treatment for chronic lymphocytic leukemia and can also help when the disease returns after treatment.
Possible side effects include diarrhea, fatigue, liver problems, high blood pressure, and issues with blood clotting.
Chemotherapy
Chemotherapy uses strong anti-cancer medicines to destroy leukemia cells. It can be given by vein or as pills and may be combined with immunotherapy.
Common side effects include nausea, fatigue, and hair loss. Some people may experience long-term complications such as heart or lung problems or a higher risk of secondary cancers.
Immunotherapy
Immunotherapy helps the body’s immune system find and kill cancer cells. It can be used alone or with chemotherapy for relapsed or treatment-resistant disease.
Possible side effects include fever, chills, dizziness, weakness, and upset stomach.
Bone marrow transplant
A bone marrow or stem cell transplant replaces damaged bone marrow with healthy stem cells, either from your body or a donor. This treatment is less common today but may be an option for relapsed or refractory leukemia.
Short-term side effects can include nausea, fatigue, mouth sores, and infections. Long-term effects may include infertility or organ damage.
CAR-T cell therapy
CAR-T cell therapy trains your own immune cells to recognize and attack leukemia cells. It is used for people whose disease has returned or not responded to other treatments.
Side effects may include fever, headache, confusion, low blood pressure, and rash.
Radiation therapy
Radiation therapy uses energy beams such as X-rays to shrink enlarged lymph nodes or relieve symptoms.
Side effects depend on where the radiation is aimed and may include fatigue and skin irritation.
Clinical trials
Clinical trials offer access to new and promising treatments that are still being studied. Ask your healthcare provider if you may qualify for a clinical trial.
Monitoring after treatment
After treatment, you may have regular follow-up appointments to check if the leukemia has returned. Blood tests and imaging scans are used to detect signs of relapse early.
Possible treatment complications
Treatment for chronic lymphocytic leukemia can lead to several complications.
• Bone marrow suppression reduces the body’s ability to make blood cells, increasing the risk of infection.
• Febrile neutropenia occurs when you have a fever and a very low white blood cell count.
• Some medicines can cause organ damage or toxicity.
• Viral infections such as hepatitis B or C may become active again during treatment.
• Tumor lysis syndrome can occur when cancer cells break down rapidly, releasing substances that can damage the kidneys and other organs.
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