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Lymphocytic leukemia is a cancer of the bone marrow. It can be a rapidly developing and more aggressive form of disease called acute lymphocytic leukemia (ALL) or a slowly developing and less aggressive form called chronic lymphocytic leukemia (CLL). In both of these forms, the bone marrow produces an excess number of abnormal lymphocytes (a type of white blood cell) that under normal conditions are responsible for fighting infection by producing antibodies (proteins that fight infection). These leukemic cells (malignant white blood cells), known as lymphoblasts in acute leukemia, adversely affect immunological response (ability to fight infections) and can accumulate in different organs such as lymph nodes, spleen, liver, brain, and spinal cord, impairing their functions. ALL and CLL affect mostly older white men but also individuals who were exposed to radiation or previous chemotherapy, have certain genetic disorders (such as Down syndrome or chromosome 22 Philadelphia), or are of Eastern European Jewish ancestry. The January 5, 2011, issue of JAMA includes an article describing factors that can affect the course of CLL.
Lymphocytic leukemia may have no symptoms initially. However, as leukemia cells replace the bone marrow, the number of red blood cells, normal white blood cells, and platelets in the blood decreases. That is why several seemingly unrelated symptoms and signs occur in lymphocytic leukemia:
Painless lumps in the neck, armpit, or groin
Fatigue and shortness of breath due to anemia (a decreased number of red blood cells)
Fever and repeated infections
Pain in bones, ribs, or abdomen
Easy bruising and bleeding due to low numbers of platelets
Loss of appetite
Lymphocytic leukemia is suspected when a patient has new lumps under the skin, pain in the bones, and easy bruising. Bone marrow and blood samples revealing an increased number of leukemic cells provide the diagnosis, and further analysis of these cells may indicate the prognosis (future course of the disease). Lymphocytic leukemia is a treatable disease and many patients enjoy their lives for many years after diagnosis. There are several treatment options depending on the aggressiveness of the disease. If the leukemia is more advanced, patients can be treated with chemotherapy (drugs that kill cancer cells) or radiotherapy (radiation to kill cancer cells). Sometimes splenectomy (surgical removal of the spleen) is necessary. Recently, a targeted therapy (drugs and antibodies that recognize and selectively destroy leukemia cells) has been developed and used. Continuation of remission (keeping the disease under control) to prevent recurrence of leukemia can also be achieved with chemotherapy. In more aggressive forms of lymphocytic leukemia, chemotherapy may be assisted by an autologous stem cell transplant (using the patient's own stem cells) and biological therapy (a boost of the immune system) to eradicate leukemic cells from the bone marrow.
National Library of Medicinehttp://www.nlm.nih.gov/medlineplus/acutelymphocyticleukemia.htmlhttp://www.nlm.nih.gov/medlineplus/chroniclymphocyticleukemia.html
National Cancer Institutehttp://www.cancer.gov/cancertopics/pdq/treatment/CLL/patienthttp://www.cancer.gov/cancertopics/pdq/treatment/adultALL/patient
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish.
Sources: National Library of Medicine, National Cancer Institute
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
This article was corrected for an incorrect heading on January 14, 2011.
Pluta RM, Lynm C, Golub RM. Lymphocytic Leukemia. JAMA. 2011;305(1):112. doi:10.1001/jama.305.1.112
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