Chronic lymphocytic leukemia (CLL) is a type of blood cancer that develops when your bone marrow produces abnormal lymphocytes, which are a type of white blood cell. The abnormal lymphocytes don’t work as well as normal lymphocytes. They also survive longer, so they build up in your body.
In the earliest stage of CLL, you have too many lymphocytes in your blood and bone marrow but no other signs of leukemia. This stage of CLL often causes no symptoms and requires no active treatment.
If you have early CLL that’s not causing symptoms or progressing quickly, your doctor may recommend watchful waiting to manage it. They won’t prescribe active treatment during watchful waiting, but they will schedule regular checkups and blood tests to monitor your condition.
If your condition shows signs of progressing, your doctor may prescribe one or more treatments.
Read on to learn more about your treatment options and outlook for early CLL.
If you are diagnosed with CLL, your doctor will order staging tests to find out how far the condition has progressed.
Stage 0 is the earliest stage of CLL. At this stage, you have too many lymphocytes in your bone marrow and blood but no other signs of leukemia.
Stage 0 often causes no symptoms. The abnormal lymphocytes tend to reproduce slowly at this stage, which means your condition may remain stable for years without treatment.
CLL may eventually progress to a more advanced stage that causes symptoms and requires treatment.
In this case, the abnormal lymphocytes may start to grow more quickly and spread to other areas, such as your lymph nodes, spleen, or liver. They may leave less room for other types of blood cells, including platelets and red blood cells. This raises your risk of infections, anemia, and abnormal bleeding.
Learn more about each stage of CLL below:
| Stage 0 | • You have too many lymphocytes. • There are no other signs of leukemia. |
|---|---|
| Stage 1 | • You have too many lymphocytes. • Your lymph nodes are larger than usual. |
| Stage 2 | • You have too many lymphocytes. • Your liver or spleen is larger than usual. • Your lymph nodes may be larger than usual. |
| Stage 3 | • You have too many lymphocytes and too few red blood cells. • Your lymph nodes, liver, or spleen may be larger than usual. |
| Stage 4 | • You have too many lymphocytes and too few platelets. • You may have too few red blood cells. • Your lymph nodes, liver, or spleen may be larger than usual. |
You can talk with your doctor to learn more about the stage of your condition.
If you have early CLL, your doctor will likely manage it with watchful waiting. This is also known as active surveillance or the watch-and-wait approach.
They won’t prescribe any active treatment during this time, but they will schedule regular checkups and blood tests to learn whether your condition is progressing. Let them know if you notice any changes in your health.
You might feel nervous about watchful waiting or eager to start treatment.
But according to the Leukemia & Lymphoma Society, the potential risks and side effects of treating CLL (with a treatment such as chemotherapy) when it’s growing slowly and causing no symptoms generally outweigh the potential benefits.
Starting treatment too early may cause side effects or complications without improving your long-term outlook. Your body may also become resistant to medications that are helpful for treating later stages of CLL.
Waiting to start treatment until your CLL progresses may help you maintain a higher quality of life for longer without negatively affecting your long-term outlook.
Talk with your doctor to learn more about managing early CLL.
Let your doctor know if you notice changes in your health, even if you’re not sure the changes are related to CLL.
Any of the following symptoms may indicate a progression of CLL:
- swollen lymph nodes in your neck, armpit, abdomen, or groin
- small, dark reddish spots under your skin, known as petechiae
- easy bleeding or bruising
- pain or bloating below your ribs
- fatigue, tiredness, or weakness
- unexplained weight loss
- night sweats
- infections
- fever
Your doctor can help you understand whether CLL or another condition is causing your symptoms.
They will order regular blood tests to check for changes in your blood cells and might collect a sample of bone marrow for analysis.
Low platelet levels, low red blood cell levels, and a sudden increase in the number of lymphocytes in your blood or bone marrow are other possible signs that CLL is progressing.
Your doctor may order imaging tests to learn whether abnormal blood cells have spread from your bone marrow and blood to other organs.
Additionally, CLL is progressing if your spleen, liver, or lymph nodes are enlarged.
If CLL starts to cause symptoms or shows signs of progression, your doctor may recommend treatment with one or more of the following:
- radiation therapy
- medication, such as:
- targeted therapy
- chemotherapy
- immunotherapy
- stem cell transplant
Allogeneic stem cell transplantation is the only potential cure for CLL, but this treatment carries a high risk of severe side effects. Your doctor may instead recommend lower-risk treatments to manage your condition.
In some cases, your doctor may recommend watchful waiting for a period of time after symptoms start to develop.
In other cases, they may prescribe treatment as soon as symptoms appear.
Your doctor may recommend a change in your treatment if:
- your condition is showing signs of progression or is progressing quickly
- your condition has started to progress again after a period of stability
- your current treatment is causing side effects that are hard to manage
- your overall health, treatment goals, or preferences have changed
- new treatments have become available
Your doctor may pause treatment if your condition stabilizes and restart treatment if it shows signs of becoming active again. Many people with CLL receive on-and-off treatment over multiple years.
Your doctor may also recommend certain vaccinations, preventive medications, or lifestyle strategies to help manage your risk of infections. Getting early treatment for infections is also important.
Your doctor will consider multiple factors when recommending treatment.
Although CLL is rarely curable, it’s possible to live for many years with this condition.
The American Cancer Society reports that the 5-year relative survival rate for CLL is
Survival rates for some people with CLL are higher than for others.
Your specific outlook depends on several factors, such as:
- your age and overall health
- how quickly the abnormal lymphocytes are increasing
- whether the abnormal lymphocytes have spread
- whether the abnormal lymphocytes have certain gene mutations
- the treatment you receive and how your body responds to it
Some people with early CLL develop symptoms and need treatment within the first few years of diagnosis, while others live for many years without developing symptoms or needing treatment.
A 2020 study found that, depending on certain risk factors, roughly 8–62% of people with early CLL need treatment within 5 years. You’re more likely to need treatment within 5 years if you have abnormal lymphocytes that test positive for certain gene mutations.
Sometimes CLL transforms into an aggressive form of lymphoma, such as diffuse B-cell lymphoma. This is known as the Richter transformation or Richter’s syndrome. It affects 2–10% of people with CLL.
Your doctor can help you learn more about your treatment options and outlook for CLL.
CLL causes abnormal lymphocytes to build up in your blood and bone marrow.
The earliest stage of CLL typically causes no symptoms and requires no active treatment. Your doctor will likely recommend watchful waiting, which involves regular checkups and blood tests to monitor your condition.
Many people live with early CLL for years without developing symptoms or needing treatment.
Your doctor may recommend treatment if you develop symptoms or if tests show that your CLL is progressing.
You can talk with your doctor to learn more about your condition, treatment options, and outlook.