Is there a link between Agent Orange exposure and CLL?

In 2002, the U.S. Department of Veterans Affairs added CLL to the list of diseases linked to Agent Orange exposure.

Of the 195 veterans who were diagnosed with CLL from 2001 to 2010, a disproportional 17 percent were exposed to Agent Orange, according to a retrospective cohort study published in 2014.

Researchers have found that the average age of CLL diagnosis in people exposed to Agent Orange was 61 versus 72 for people who were not exposed.

When adjusted for age, it was found that the hazard ratio of developing CLL after Agent Orange exposure was 1.9, meaning people exposed were almost twice as likely to develop CLL as those not exposed.

Agent Orange is linked to the development of a number of other types of cancers as well. It’s thought that alterations in cellular signaling are the underlying cause for cancer cell growth. Cellular signaling is the ability of your cells to communicate with each other.

A 2017 study found evidence that the prognosis and survival rate of Agent Orange-exposed veterans diagnosed with CLL is similar to those of the general population.

Agent Orange exposure is linked to a number of other cancers and illnesses in addition to CLL. The U.S. Department of Veterans Affairs links it to the following:

Cancers

• bladder cancer
• Hodgkin’s disease
• multiple myeloma
• non-Hodgkin’s lymphoma
• prostate cancer
• lung cancer
• other respiratory tract cancers
• some types of soft tissue sarcomas

Other illnesses

• light chain amyloidosis
• chloracne
• type 2 diabetes
• hypothyroidism
• coronary artery disease
• parkinsonism
• Parkinson’s disease
• early onset peripheral neuropathy
• porphyria
• spina bifida birth defects

CLL typically does not cause early symptoms. It’s often caught after receiving a blood test for an unrelated issue. As the disease progresses, it may cause symptoms such as:

• frequent infections
• fatigue
• shortness of breath
• pale skin
• bleeding or bruising easily
• fever
• night sweats
• swollen lymph nodes, especially in your groin, armpits, or neck
• swelling or pain in your gut
• unintentional weight loss
• loss of appetite

If you have symptoms of CLL, your doctor will likely review your medical history first to look for risk factors such as a family history of CLL. They will also likely do a physical exam to look for swollen lymph nodes and other signs of disease.

If they suspect you may have leukemia, they will order other tests such as the following:

• Blood test. During this test, a blood sample will be taken to make a blood smear to look at under a microscope to look for evidence of irregular lymphocytes. A complete blood count can measure levels of your blood cells. Having more than 10,000 lymphocytes per cubic millimeter strongly suggests CLL, according to the American Cancer Society. Lymphoctyes are a type of white blood cells.
• Bone marrow biopsy. Your doctor may want to extract a sample of bone marrow to examine the cells under a microscope. They’ll extract a small sample of bone marrow by inserting a long needle into one of your bones.
• Flow cytometry. Flow cytometry uses a machine to examine your lymphocytes to look for markers of CLL.
• Imaging tests. Imaging techniques such as a CT scan or ultrasound may be used to look for signs of swollen lymph tissue.
• Cytogenetics. Your blood and bone marrow cells may be examined in a lab to look for certain gene mutations common in people with CLL.

Six types of treatments are commonly used for CLL. These include:

• Watchful waiting. No treatment is administered unless the disease progresses.
• Chemotherapy. A drug therapy that uses chemicals to destroy cancer cells. Chemotherapy also damages healthy cells.
• Targeted therapy. A drug therapy that involves taking medications that can identify cancer cells and attack them. Targeted therapy tends to leave your healthy cells largely unaffected.
• Radiation therapy. High-energy radiation is used to kill cancer cells and reduce pain related to swollen lymph nodes or a swollen spleen.
• Immunotherapy. A form of cancer treatment that stimulates your immune cells to target cancer cells.
• Chemotherapy with bone marrow transplant. Bone marrow cells are transplanted from a donor to replace the cells damaged during chemotherapy. Your own cells can also be used by extracting them before receiving chemotherapy.

Research has found that people exposed to Agent Orange who have CLL are more likely to be initially treated with fludarabine-based chemotherapy, likely due to diagnosis at a younger age.

Agent Orange was an herbicide used primarily during the Vietnamese War. Exposure is linked to a wide range of health conditions including CLL and other cancers. People exposed to CLL seem to be almost twice as likely to develop CLL than people not exposed.

Veterans who may have come into contact with Agent Orange can receive a free health exam from the U.S. Department of Veterans Affairs. You may qualify for disability if you have a health condition linked to Agent Orange exposure.