FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

CHRONIC LYMPHOCYTIC LEUKEMIA NOT AN IMMEDIATE "DEATH SENTENCE"

Question: My husband has been diagnosed with chronic lymphocytic leukemia. The doctor explained that he has something wrong with his blood, but I was so worried that I don't remember most of what he said. Would you please explain about his illness?

Answer: Chronic lymphocytic leukemia is a form of cancer, but before I tell you more about it, I would like to respond to an important statement you made. You reported that you don't remember very much of what the doctor told both of you about your husband's illness. This is very typical of the way we all react to shocking news. Once one hears the diagnosis, our mind races through the thousands of ramifications of a possible life-threatening illness. We are temporarily unable to concentrate on the majority of information the doctor provides. Studies show that most people retain only 10 to 20 percent of the information a physician provides under these types of circumstances. So, your experience is rather typical.

Chronic lymphocytic leukemia (CLL) is a cancer that affects special immune system cells called lymphocytes that play an important role in helping the body fight disease. Cancerous lymphocytes resemble normal ones but they aren't effective at combating infection. Also, the CLL cells grow at such a vigorous rate that they suppress the growth of normal lymphocytes and other components of the blood. As the cancer progresses, it spreads to lymph nodes throughout the body, the liver and the spleen. It causes enlargement in all of these organs and interferes with their normal functioning.

However, most individuals with CLL don't feel ill, at least not until late in the disease. Chronic lymphocytic leukemia is often diagnosed from a blood count that is done because of enlarged lymph nodes or simply as part of a regular physical exam.

As you may have deduced from the name, the "chronic" of CLL implies that this is a disease which progresses slowly at least slowly when compared to most other cancers. Many people live with this disease for 15 or more years but not all are this lucky. Those who have many enlarged lymph nodes, enlarged liver and spleen, and infection at the time of diagnosis will probably not live as long. The average survival for those with these more advanced symptoms is only four years.

Sufferers of this disease complain of repeated episodes of infection. Bronchitis, sinusitis, pneumonia, and urinary tract infections are the most common. Fortunately, antibiotics are effective at clearing up most of these, and other measures, such as avoiding crowds and individuals with obvious colds, can reduce the frequency of respiratory infections.

There are several treatments none of them perfect that are currently used to help those with CLL. The standard "first line" treatment for early CLL is simply frequent checkups. This "watchful waiting" phase may last for many years. However, if the patient doesn't die of something else first, it will eventually become necessary to start some form of active treatment. The "active treatment" phase is usually begun only when the blood count has become quite abnormal or organs have become dangerously enlarged.

Radiation has been tried in some cases, but it has proved to be of limited benefit for most people. Surgery is sometimes necessary to remove a severely enlarged spleen or lymph nodes that are pressing on other vital organs such as the ureters. There are several different chemotherapy drugs that can slow the progress of advance-stage CLL, but none of them will cure it.

So, please go back to your husband's doctor and ask him or her the many questions you have. I suggest that you write your questions down as you think of them while you are at home. Otherwise, you may forget to ask one or more of them.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.