Symptoms

Many people with chronic lymphocytic leukemia have no symptoms at first. Signs and symptoms might develop as the cancer progresses. They might include:

• Enlarged, but painless, lymph nodes
• Fatigue
• Fever
• Pain in the upper left portion of the abdomen, which may be caused by an enlarged spleen
• Night sweats
• Weight loss
• Frequent infections

 

Diagnosis

Blood tests: The care team may order several blood tests as part of the CLL diagnosis process.

• Complete blood count (CBC):CLL is often discovered during routine blood tests. One common test, called a complete blood count (CBC), reveals the levels of different blood cells in the blood, which helps indicate CLL or another related condition. A high white blood cell count on a CBC suggests that the individual may have CLL or another leukemia or related disease.
• Flow cytometry and cytochemistry:Cells collected during a blood test are analyzed using methods called flow cytometry and cytochemistry. These tests may reveal the specific type of leukemia cell present in the blood, differentiating CLL cells from other types of leukemia
• Genomic testing:The DNA of the cells may also be analyzed in the laboratory to discover whether it contains specific genetic mutations that indicate whether the cancer is progressing quickly or slowly.

Bone marrow aspiration and biopsy: This procedure is generally not needed to diagnose CLL, as blood tests are good at discovering cancerous cells. However, some patients may have this test done before treatment to reveal more about the cancer.

Imaging tests: Imaging tests, such as X-rays and computed tomography (CT) scans, use different techniques to generate images inside the body. These scans are generally not needed to diagnose CLL but may be used to discover where cancer has spread.

Treatment

• Chemotherapy

 Chemotherapy is the main treatment option. Doctors use a combination of several medicines that suppress cancer cells. Chemotherapy is carried out in cycles of 3-4 weeks. There are breaks between them so that the body can recover.

Most patients with chronic lymphocytic leukemia are elderly people. Chemotherapy may not be safe for them. patients are carefully examined to make sure that it will be safe for their health to use standard doses of chemotherapy drugs. Age itself is not a contraindication to chemotherapy, but in the presence of concomitant pathologies, doctors can use more sparing treatment regimens.

To conduct chemotherapy for chronic lymphocytic leukemia, doctors use alkylating agents, purine analogs and glucocorticoids. They are often combined with monoclonal antibodies.

Monoclonal antibodies 

 

In countries with advanced medicine, monoclonal antibodies are part of the standard treatment for chronic lymphocytic leukemia. Doctors use drugs that target the CD20 antigen. Some medications can be used as first-line therapy in addition to standard chemotherapy. They can also be applied instead of chemotherapy if it is contraindicated due to the patient's weakened health. Other monoclonal antibodies are prescribed as second-line medicines if chronic lymphocytic leukemia recurs after treatment.

Less commonly, other monoclonal antibodies can be used. These antibodies are targeting the CD52 receptors. Such medicines are used as second-line agents. They can also be applied as a standard treatment option for chronic lymphocytic leukemia with chromosome 17 deletion.

To treat chronic lymphocytic hairy cell leukemia, the medicines targeting CD22 are used. Doctors use an antibody-drug conjugate. It contains two components, namely, a substance that can bind to the CD22 receptor and a toxin that is delivered to the cancer cell and destroys it.

• Targeted therapy 

 Targeted therapy is first-line treatment for patients with chronic lymphocytic leukemia. This means that the therapy is prescribed immediately after the detection of pathology, but not in case of its relapse or failure of other treatment options.

Doctors use BTK (Bruton's Tyrosine Kinase) inhibitors. They are taken in pills or capsules. The medicines are used as first-line therapy and for recurrence of chronic lymphocytic leukemia. The treatment is effective in patients with chromosome 17 deletion. BTK inhibitors have few side effects, but they suppress bone marrow function. Blood contains too few red blood cells, platelets and leukocytes. Both immunity and blood clotting are impaired, which can adversely affect the health of patients.

PI3K inhibitors can be used only as second-line therapy. The drugs are prescribed if other treatments have failed. They are also taken in pills.

 

• Stem cell transplant 

 With chronic lymphocytic leukemia, stem cell transplant can be performed less frequently than in acute. Typically, chemotherapy, monoclonal antibodies, and targeted therapy can successfully restrain the progression of the disease. In addition, mostly elderly people get sick, and they are not always healthy enough to perform this procedure, which is unsafe for health.

Nonetheless, in some cases, cancer returns. For repeated treatment of the disease, standard therapy options are not always effective. Failures are especially common in prognostically unfavorable types of chronic lymphocytic leukemia: with chromosome 17 deletion and TP53 mutation.

In theory, any, even the most aggressive, tumors can be suppressed with chemotherapy. This is purely a matter of dosage. But in practice, it will not work to increase the dose indefinitely, because healthy cells are also affected by chemotherapy, and primarily those that are quickly divided. The high-dose chemotherapy has high toxicity to the bone marrow, which dies and stops producing healthy blood cells.

The problem can be solved with stem cell transplant. Doctors carry out high-dose chemotherapy. It destroys not only the tumor, but also the patient's own bone marrow. To restore it, stem cells are injected into the blood, either the patient's own or donated ones. Previously, they were obtained from bone marrow, which is why the procedure is called bone marrow transplant. But in modern medicine, cells are more often taken from the patient's peripheral blood.

Depending on which cells are used for the transplant procedure, the transplantation can be:

• Allogeneic – cells obtained from a donor.
• Autologous – the patient's own cells.

Autologous transplantation is safer. The cells are definitely not rejected, and they do not cause a graft-versus-host disease. Nonetheless, the disadvantage of this method is that it is almost impossible to cure cancer. Together with stem cells, malignant cells inevitably enter the bloodstream, and thus they give rise to the growth of a new tumor. Therefore, sooner or later, cancer will recur.

When treating chronic lymphocytic leukemia, doctors often use allogeneic transplantation. It is better if there is a suitable donor from among the next of kin. The donor must be compatible for the main antigens. The more antigens match, the higher the chance of a successful outcome of the procedure.

Chronic lymphocytic leukemia can be cured with allogeneic transplantation. Firstly, transplantation does not imply the transfer of malignant cells into the patient's blood. Second, after new bone marrow is formed, it attacks the remaining cancer cells more aggressively by activating the graft-versus-cancer disease.

 

• Radiotherapy 

 While radiotherapy is one of the main treatment options for other types of cancer, it can rarely be used for leukemia. Radiotherapy does not affect the patient's survival rate. It is mainly used to relieve symptoms.

The three most common situations when doctors use radiotherapy for chronic leukemia are:

1. The development of tumor foci, most often in the spleen, which squeeze the surrounding organs, for example, the stomach. They can block the passage of food, disrupt blood flow, and cause severe pain. Chemotherapy is effective in eliminating these tumor foci, but under the influence of drugs, they gradually regress. If the tumor needs to be reduced quickly, radiotherapy becomes an option of choice.
2. Tumor foci in the bones. They cause a lot of pain. Bone irradiation aims to relieve pain.
3. Prior to stem cell transplant. In recent years, doctors increasingly use only high-dose chemotherapy. Nevertheless, some patients also receive small doses of radiation to the whole body to reduce the risk of leukemia recurrence after bone marrow transplant. 

 

• Surgical treatment 

 Surgical operations for chronic leukemia can rarely be performed. They do not help cure this disease.

Sometimes doctors perform surgery to remove the spleen. It is required if the enlarged spleen presses on the surrounding organs, but it is not possible to reduce its size with the help of chemotherapy and irradiation.

The spleen is the organ responsible for the destruction of blood cells. Therefore, its removal has an additional positive effect on the clinical course of the disease. In hairy cell leukemia, splenectomy can sometimes be performed in order to increase the number of cells and reduce the need for blood transfusions.

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1-Diagnosis:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical blood test
• inflammation markers (CRP, ESR)
• blood coagulation analysis (aPTT, PT, INR)
• differential blood count
• ultrasound, CT scan.
• aspiration biopsy of bone marrow (if clinically indicated)
• immunohistochemical study
• cytogenetic analysis (Philadelphia chromosome detection)
• tumor board (medical oncology, radiotherapy, radiologist).
• nursing services
• treatment by chief physician and all leading experts
• explanation of individual treatment plan

 

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Bone marrow biopsy results (if available)

Price from: on request

Type of program: Outpatient

Expected duration of the program: 6 days

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2-Chemotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• blood smear
• TSH-basal
• inflammation indicators
• indicators blood coagulation
• CT scan of full body, ultrasound of spleen