What is chronic (lymphoid) leukemia?

Former Italian Prime Minister Silvio Berlusconi East hospitalized since April 5 in intensive care to treat a lung infection. old 86 years old, he is suffering from chronic leukemia, according to his doctors. Leukemia is a blood cancer of which there are chronic forms because slower moving. Among the chronic leukaemias, those called “myeloid“and those said”lymphoid” (the most frequent). The name varies according to the origin of the affected cells. Leukemia chronic lymphoid affects men twice as often that women, especiallyt around 70 years old. What is his gravity? What lifespan? What are the symptoms of chronic lymphocytic leukemia? The causes ? What tests to make the diagnosis?

What is the definition of chronic lymphocytic leukemia?

There chronic lymphocytic leukemia (CLL) East a disease affecting blood cells called B lymphocytes. These cells play an important role in immune system, providing defense against external agents (bacteria, viruses, fungi, etc.). “This disease causes multiplication and accumulation of abnormal lymphoid cells in the bloodlymph nodes, spleen and bone marrow, which explains the increase in these cells in the blood and possibly the increase in volume of one or more of these organs”explains Dr. Jacques Vargaftig, onco-haematologist at the Curie Institute.

What is the lifespan in case of CLL?

According to figures from the National Cancer Institute, the 5-year survival rate for chronic lymphocytic leukemia is over 80%.

What are the symptoms of chronic lymphocytic leukemia?

At first, people with this form of chronic leukemia do not feel usually no signs of the disease. This goes completely unnoticed. It is therefore common for chronic leukemia not to be diagnosed until several years after its appearance. “In fact, the main manifestations of CLL are observed in the blood, with a too many B cells. Abnormal results for other blood elements (hemoglobin and platelets in particular) can also be observed, but they are not constantly found. emphasizes the specialist. It is when the disease progresses that certain physical signs may be felt. It is thus possible that enlarged lymph nodes than in ordinary times. Signs such as fatigueof the fever or one shortness of breath can occur during CLL.

What are the different stages?

Unlike other forms of so-called acute leukemia which progress rapidly, chronic leukemia is a slowly progressing disease. That’s why doctors consider it a chronic disease. According to Binet’s classification, there are three stages, which are based on the number of red blood cells and platelets in the blood as well as the number of areas of swollen lymph tissue:

• Stage A : It corresponds to a “simple” increase in the number of B lymphocytes, without any other blood abnormality, with the absence or very limited presence of lymph nodes.
• Stage B: It corresponds to an increase in the number of B lymphocytes, without any other blood abnormality, but associated with the presence of lymph nodes in several lymph node territories.
• Stage C : It corresponds to an increase in the number of B lymphocytes associated with other blood abnormalities: anemia (decrease in the hemoglobin level) and/or a decrease in the number of blood platelets.

At the time of diagnosis, nearly two-thirds of people with CLL are in stage A, and only a minority are in stage C.

What is chronic relapsing leukemia?

A chronic lymphocytic leukemia recurrence recurs after treatment and remission. Remission is usually defined as a decrease or disappearance of signs and symptoms and an increase in the number of blood cells. If CLL comes back, doctors may re-stage it. This is restaging.

What is refractory chronic leukemia?

There chronic lymphocytic leukemia is refractory when it has not responded to treatment.

What causes chronic lymphocytic leukemia?

No cause or risk factor for chronic lymphocytic leukemia has been formally identified. A familial predisposition may be suspected in some cases.

CLL is a disease affecting blood cells. Its diagnosis is therefore established on a simple blood test.

► The number of lymphocytes: First, what is called a complete blood count or blood count is performed. This is a very common test that involves counting the different types of blood cells. The diagnosis of CLL can be considered if the number of lymphocytes is higher than normal values. As a transient increase in blood cells is always possible (following a viral infection for example), the lymphocyte count must be repeated to confirm the anomaly.

► The characteristics of lymphocytes: for it to be formally established, the diagnosis of CLL requires studying the lymphocytes under a microscope. In the case of CLL, the appearance of these cells in fact presents specific characteristics that allow them to be identified and to eliminate other diseases associated with an abnormally high number of lymphocytes.

► Immunophenotyping: the determination of the immunophenotype consists in studying precise markers (antigens) on the surface of the lymphocytes. When they are present, these markers are in a way the “signature” of the disease. This examination thus confirms the diagnosis of CLL. Immunophenotyping is performed by a specialized laboratory.

Most of the time, no other additional examination is necessary to establish the diagnosis of CLL. It is however possible thata scanner is requested by the doctor, in particular when he detected lymph nodes during the clinical examination. “In addition, you can also request an analysis of the chromosomes (of a karyotype) as well as of certain genes“, adds Dr. Vargaftig.

What treatment to treat chronic lymphocytic leukemia?

The treatment of chronic lymphocytic leukemia is not systematic and depends on each patient. Indeed, CLL can long require only careful and regular monitoring when there are no troublesome signs. Medium and high riskit may require a chemotherapy and antibody-based treatments monoclonal. Corticosteroids are, in certain situations, associated with chemotherapy. These drugs are administered either by venous infusion, or by subcutaneous injection, or orally (tablets or capsules that are swallowed). If a treatment must be initiated, it is administered by regular courses of products adapted to each case. These cures are repeated at an interval usually of a few weeks. The total duration of treatment is 3 to 12 months. Even if current treatments make the signs of the disease disappear in appearance, they cannot eliminate all of the diseased cells. Thus, after a more or less long period of normalization, a reappearance of symptoms occurs in the majority of patients. It is then possible to initiate a new treatment”, says the doctor. As with any chronic disease, CLL requires regular medical follow-up, even if no treatment is taken. This medical follow-up usually requires only regular consultations and blood tests.

Thanks to Doctor Jacques Vargaftig, MD-PhD, from the Hematology/Medicine E department at René Huguenin Hospital – Institut Curie.