CHRONIC LYMPHOCYTIC LEUKEMIA

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Regina Barrett
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1 CHRONIC LYMPHOCYTIC LEUKEMIA This medical guide is designed for educational purposes to help patients understand. Please consult your doctor on specific questions and details about your symptoms.

02 03 CHRONIC LYMPHOCYTIC LEUKEMIA What does the bone marrow do? The bone marrow is the spongy tissue comprising the center of large bones such as the hip or leg bones.

2 02 03 CHRONIC LYMPHOCYTIC LEUKEMIA What does the bone marrow do? The bone marrow is the spongy tissue comprising the center of large bones such as the hip or leg bones. 1 The bone marrow contains blood stem cells that produce red blood cells, white blood cells, and platelets. 1 Blood stem cells: stem cells that give rise to all types of blood cells, including red blood cells, white blood cells, and platelets Contents Spongy bone (contains blood stem cells) What does the bone marrow do? What is (CLL)? What causes CLL? What are the symptoms of CLL? How is CLL diagnosed? How is CLL treated? Living with CLL Frequently asked questions Blood stem cells Red blood cells White blood cells Platelets

04 05 What is chronic lymphocytic leukemia? Chronic lymphocytic leukemia (CLL) occurs when the white blood cells in the bone marrow called lymphocytes start to grow abnormally.

3 04 05 What is chronic lymphocytic leukemia? Chronic lymphocytic leukemia (CLL) occurs when the white blood cells in the bone marrow called lymphocytes start to grow abnormally. 1 These abnormal white blood cells cannot develop properly and are not able to fight infections very well. Additionally, as the number of the abnormal white blood cells increase, there is less room for your healthy white blood cells, red blood cells, and platelets. 1 What causes CLL? The exact cause of CLL remains unknown. However, the strongest and most consistent risk factor for CLL is family history of any hematologic malignancy. 2,3 Studies show that the risk of having CLL increases by 6-9 times if you have family members with CLL. 4 Normal blood Leukemia Other risk factors include: 1,4,5 1Age CLL is more common in people over 60 and is very rare in people under 40. Platelets Red blood cell White blood cells Abnormal proliferation of white blood cells 2Gender Overall, CLL occurs more often in men than in women. 3 Exposure to certain chemicals Exposure to some chemicals such as weedand insect-killing substances may be linked with an increased risk of CLL.

4 06 07 What are the symptoms of CLL? How is CLL diagnosed? CLL usually does not cause any signs and symptoms in its early stages until diagnosed. Therefore, symptoms are often picked up during a blood test carried out for other reasons. 6 Lymph nodes: small, bean-shaped glands throughout the body carrying fluid (lymph fluid), nutrients, and waste material between the body tissues and the bloodstream Confirming the diagnosis may require a combination of physical examinations, laboratory tests, gene tests, and imaging tests (CT/MRI/PET scans or ultrasound). 7 The most common symptoms of CLL include: 6 Diagnosis of CLL 7 Swollen lymph nodes (felt as lumps under the skin) Night sweats Fatigue Unexplained weight loss Fever Weakness Physical exam To check for symptoms and signs of CLL Blood test To check general health and white and red blood cell levels Bone marrow tests To examine bone marrow samples for cancerous cells Gene tests To examine changes in the DNA and genetic markers indicative of CLL Imaging tests To check the spread of cancer through detailed images of the body CT (computerized tomography) scan: a type of scan that uses a series of X-rays that build up a 3D picture of inside the body MRI (magnetic resonance imaging) scan: a type of scan that uses strong magnetic fields and radio waves to produce detailed images of inside the body PET (positron emission tomography) scan: a type of scan that uses a radioactive drug (tracer) to produce detailed 3D images of the body Ultrasound: a type of scan that uses sound waves and their echoes to produce a picture of internal organs or masses

5 08 09 How is CLL treated? The main goal of treatment is to help you improve your quality of life by reaching remission. The form of treatment chosen depends on the stage of CLL, as well as other factors including your age, overall health, and benefits and risks of treatment. 8 Once you develop symptoms that are severe enough for treatment, your options may include: 9,10 Staging of CLL Remission: the disappearance of signs and symptoms of the disease (when a patient is in remission, disease activity cannot be detected in the body) Chemotherapy Chemotherapy is a drug treatment, given orally or by injection, that kills cancer cells. Radiation therapy During radiation therapy, you are positioned on a table and a large machine directs radiation at precise points on your body to kill cancerous cells and shrink tumours. STAGE A STAGE B STAGE C Have enlarged lymph nodes in fewer than three areas and a high white blood cell count Have enlarged lymph nodes in tree or more areas and a high white blood cell count Have enlarged lymph nodes or an enlarged spleen, a high white blood cell count, and a low red blood cell or platelet count Spleen: an organ found in the upper left part of the abdomen that filters the blood and helps the immune system fight infection Modified from the Binet system Biological therapy Stem cell transplant WAIT If your symptoms are mild and thought to be low-grade, starting immediate treatment may not be necessary. In this case, your doctors may decide to wait and see until you develop symptoms, or tests show that the condition is getting worse. 8 Biological drugs help your body s immune system fight cancer. For example, a biological drug called rituximab attacks the cancerous cells in the body so that the body s immune system can destroy them. After cancer cells are killed with high dose chemotherapy, healthy stem cells (your own or from a donor) are injected into your body, where they can form new healthy blood cells.

6 Living with CLL Frequently Asked Questions A diagnosis of cancer can be overwhelming. At first, you are likely to feel very upset, frightened and confused. 11 While you cannot change the fact that you have cancer, you can make changes in your daily life by: 1. Will treatment affect my appearance and physical image? 14 Treatments like surgery, chemotherapy and radiotherapy can change the way your body looks, works or feels. The effects may vary depending on the treatment, but it is common for patients to experience hair loss, dry skin, rashes, brittle nails during treatment. However, most symptoms will disappear once treatment is completed. 2. What are common complications of CLL? 15 If you have CLL, you are likely to have a weakened immune system and become vulnerable to infections because you have a lack of healthy, infection-fighting white blood cells. 1 in 10 people with CLL experience severe anaemia, and 1 in 20 people with CLL experience Richter s syndrome, in which CLL develops into an aggressive form of cancer known as lymphoma. Psychologically, you may feel anxious and depressed because of your condition. Frequently communicating with your doctor through regular check-ups to stay well informed about your symptoms and treatment. 12 Eating a healthy diet, getting to and staying at a healthy weight, and limiting your alcohol intake. 13 Exercising to help reduce fatigue and cope better physically and emotionally. Studies have shown that patients who follow an exercise program tailored to their personal needs feel better and cope better What is the outlook for patients with CLL? 16 The outlook for patients with CLL depends on how advanced it is, when it s diagnosed, how old you are when diagnosed, and your general health. Overall, around 3 in 4 people with CLL will live at least five years after diagnosis, and many live much longer if they discover their symptoms and start treatment early on. Questions

7 CHRONIC LYMPHOCYTIC LEUKEMIA REFERENCES 1. ANational Cancer Institute. Treatment (PDQ ) Patient Version. Available at: 2. Lynn R. Goldin, Susan L. Slager, Neil E. Caporaso. Curr Opin Hematol. 2010;17(4): David Oscier, Claire Dearden, Efrem Erem, et al. British J of Haematology. 2012;159: Cancer Research UK.. Risks and causes. Available at: 5. American Society of Clinical Oncology. Leukemia. Chronic Lymphocytic. CLL: Risk Factors. Available at: Accessed March American Cancer Society. Signs and symptoms of? Available at: html 7. American Cancer Society. How Is Diagnosed? Available at: cancer.org/cancer/chronic-lymphocytic-leukemia/detection-diagnosis-staging/how-diagnosed.html Accessed Mar NHS Choices. Treating chronic lymphocytic leukaemia. Available at: 9. National Health Service UK. Treating chronic lymphocytic leukaemia. Available at: Conditions/leukaemia-chronic-lymphocytic/Pages/Treatment.aspx 10. Mayo Clinic. Treatment. Available at: Cancer Research UK. Living with. Coping. Available at: cancerresearchuk.org/about-cancer/chronic-lymphocytic-leukaemia-cll/living-with/coping Accessed March American Society of Clinical Oncology. Leukemia. Chronic Lymphocytic. CLL: Follow-Up Care. Available at: Accessed March American Cancer Society. Lifestyle Changes During and After Treatment for Chronic Lymphocytic Leukemia. Available at: lifestyle-changes.html 14. Macmillan cancer support. What might happen. Available at: changes-during-treatment/what-might-happen.html 15. NHS Choices. Complications of chronic lymphocytic leukaemia. Available at: NHS Choices. Chronic lymphocytic leukaemia. Available at: Celltrion Healthcare Co., Ltd HCTRU-00 PB-0317/02

NON- HODGKIN LYMPHOMA

NON- HODGKIN LYMPHOMA non - Hodgkin lymphoma This medical guide is designed for educational purposes to help patients understand. Please consult your doctor on specific questions and details about your