Brief overview
- Forms: There are two forms of lymphocytic leukemia: acute lymphocytic leukemia (ALL) develops rapidly, while chronic lymphocytic leukemia (CLL) develops slowly.
- Symptoms: Pallor, decreased performance, fatigue, bleeding tendency, bruising, later fever, vomiting, and bone and joint pain typical, sometimes neurological disorders.
- Diagnosis: blood test, ultrasound examination, taking tissue samples (biopsy), magnetic resonance imaging (MRI) and computed tomography (CT).
- Treatment: surgery, radiation and/or chemotherapy, immunotherapy, in some cases stem cell transplantation.
- Prognosis: Most ALL patients (especially children) can be cured; in CLL, doctors try to slow the progression of the disease; stem cell transplantation offers a chance of cure.
What is lymphatic leukemia?
The term “lymphatic leukemia” is used by physicians to describe cancers that originate from the so-called lymphatic precursor cells, which are formed during blood formation.
All blood cells (red blood cells, white blood cells and platelets) have a common origin – the blood stem cells in the bone marrow. Two types of progenitor cells develop from these stem cells: lymphoid and myeloid progenitor cells.
In lymphocytic leukemia, the formation of B lymphocytes in particular is disturbed. Large quantities of immature B lymphocytes are produced, which multiply uncontrollably. As a result, they increasingly push back the mature, healthy blood cells. This means that over time there are fewer and fewer of the other subgroups of white blood cells. At the same time, a deficiency of red blood cells and platelets develops.
Forms of lymphocytic leukemia
Acute Lymphoblastic Leukemia (ALL)
Acute lymphoblastic leukemia begins quite suddenly and progresses rapidly. It is the most common form of leukemia in children. About 80 percent of all children with leukemia have ALL. Children under the age of five and adolescents are the most commonly affected. It is only in people over the age of 80 that ALL occurs more frequently.
Chronic Lymphocytic Leukemia (CLL)
Chronic lymphocytic leukemia is considered a low-grade malignancy and develops insidiously and slowly, usually over many years. In some cases, the disease persists for a long time without noticeable symptoms. CLL is the most common form of leukemia in Western industrialized countries. According to the Robert Koch Institute (RKI), CLL accounted for about 37 percent of all leukemias in Germany in 2017/2018.
Despite its name, chronic lymphocytic leukemia is no longer considered a leukemia (“blood cancer”), but is considered a form of lymphoma (more precisely, non-Hodgkin’s lymphoma).
Symptoms of lymphocytic leukemia
Symptoms of ALL
Because the cancer cells also displace the platelets, a tendency to bleed (such as gum and nose bleeds) develops. These individuals also bruise easily (hematomas). One also often observes pinpoint hemorrhages in the skin and mucous membranes. Physicians refer to them as petechiae.
If the cancer cells have affected the central nervous system (brain and spinal cord), headaches, vomiting, listlessness, and nerve loss and paralysis may occur.
Symptoms of CLL
Some individuals develop fever, sweat at night, and are prone to infections and bruises (hematomas). Signs of anemia also occur (pallor of the skin and mucous membranes, rapid fatigue, dizziness, etc.). Some people with chronic lymphocytic leukemia report skin changes. However, apart from pallor and bruising, these are not among the typical symtpoms of CLL.
To read more about the signs of leukemia, see Leukemia: Symptoms.
The triggers for the underlying cell changes are hardly known. What is clear is that there are changes in the genetic material and corresponding gene defects, as a result of which the lymphocytes develop incorrectly. These defective genes can sometimes be detected in infancy, but do not lead to disease in all cases. Experts therefore suspect that it is an interplay of various internal and external factors.
For more information on possible causes of leukemias, see Leukemias: Causes and Risk Factors.
Lymphocytic leukemia: examinations and diagnosis
Diagnosis of ALL
This is followed by a physical examination. This should provide information about the general condition of the person affected.
Blood tests and a bone marrow puncture are particularly important if acute lymphatic leukemia (or any other form of leukemia) is suspected. In the latter, the doctor takes a sample of the bone marrow and has it examined in detail in the laboratory. This allows ALL to be detected with certainty.
In addition, there are usually other examinations, for example electrocardiogram (ECG), imaging procedures (such as X-ray, ultrasound) and an examination of the cerebrospinal fluid (lumbar puncture). These serve either to better assess the physical condition of the affected person or to check the spread of the cancer cells in the body.
Diagnosis of CLL
In some cases, it is necessary to take a tissue sample (biopsy) of the lymph nodes and analyze it in the laboratory. This makes it possible to determine whether and how far the disease has spread. For the same reason, the doctor performs an ultrasound examination of the abdomen, for example. In some cases, a bone marrow examination is also useful here.
You can read more about the various examinations under Leukemia: Examinations and Diagnosis.
There are various therapeutic approaches for both acute lymphoblastic leukemia and chronic lymphocytic leukemia.
Therapy of ALL
Doctors usually treat people with acute leukemia (such as ALL) as quickly as possible. In this way, it is sometimes possible to achieve a complete regression of the disease (remission).
Other treatment approaches for acute lymphoblastic leukemia include stem cell transplantation and radiation therapy. In stem cell transplantation, blood stem cells are transferred to the patient. The goal is for these to give rise to new, healthy blood cells. The main purpose of radiation therapy for ALL is to prevent or treat cancer in the brain.
You can read more about the treatment options for blood cancer under Leukemia: Treatment.
Therapy of CLL
Many people with CLL do not feel ill and have no symptoms for years because the disease progresses very slowly. In this case, no therapy is usually necessary; instead, doctors wait and only perform regular check-ups (“watch and wait”).
Often, the physician then initiates a so-called chemoimmunotherapy (or immunochemotherapy). This means that the patient receives chemotherapy in combination with immunotherapy. The cancer drugs (cytostatics) used in chemotherapy are taken as tablets or administered via infusion.
For some individuals with chronic lymphocytic leukemia, chemotherapy or immunotherapy alone may also be considered. More rarely, additional radiation therapy or surgery is necessary. This is the case, for example, if lymph nodes are affected by the cancer cells and cause complications.
If the first cancer treatment is unsuccessful or the cancer returns, stem cell transplantation may be considered in some cases. This involves first using high-dose chemotherapy to kill all the bone marrow and (hopefully) all the cancer cells. Afterwards, blood stem cells from a donor are transferred to the patient, from which new, healthy blood cells are produced.
Life expectancy in lymphocytic leukemia
Prognosis of ALL
In recent decades, the number of people with ALL who have been cured has increased. Especially in children, the chances of cure are usually good. Five years after diagnosis, approximately 70 percent of adults and 95 percent of affected children are still alive with proper treatment. After ten years, survival rates are about 33 percent in adults and 70 percent in children.
Prognosis of CLL
Chronic lymphocytic leukemia (CLL) is considered the “most benign” form of leukemia. The disease usually progresses slowly and without major symptoms. If treatment is necessary, CLL can usually be reduced and its progression slowed down. However, according to the current state of knowledge, only risky stem cell transplantation offers a chance of a cure.
Particularly dangerous for those with the disease is that their weakened immune system makes them susceptible to infections. Infections that cannot be controlled are therefore also the most common cause of death in people who have chronic lymphocytic leukemia (or another form of leukemia).
Lymphocytic leukemia: prevention
As with other leukemias, there are currently no proven measures that can be used to prevent lymphocytic leukemia.
