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Complications

Unfortunately there are several complications that can occur with CLL.

complications of cll

Secondary Cancers

Having CLL places you at a higher risk of developing secondary cancer(s) and other disorders.

Those that most often occur include:

  • Colorectal cancer
  • Lung cancer
  • Acute myeloid leukaemia
  • Soft tissue sarcoma
  • Melanoma
  • Squamous cell skin cancer
  • Basal cell carcinoma (high recurrence rate)

To lessen the risk of developing skin cancer(s) you should protect your skin from the harmful effects of the sun by wearing sunblock. If you notice any change in your skin go to your doctor so that you can be examined properly.

ITP: Immune Thrombocytopenia

ITP (immune thrombocytopenia purpura, or idiopathic thrombocytopenia purpura) is an autoimmune disease which attacks platelets.

Platelets are an essential component of blood, and they are necessary for proper clotting of blood. People with very low platelet levels are at danger of prolonged bleeding if they cut themselves, and at risk of life threatening internal haemorrhages, stroke etc. Patients with uncontrolled ITP may require hospitalization and transfusions.

A number of things can cause platelet counts to drop below safe limits.

  • One of the complications of CLL is a swollen spleen that is clogged with CLL cells, which are unable to get back into blood circulation to do their work. In situations like this, the bone marrow will try its best to compensate, create more platelets to make up for the losses in the spleen – and this can be seen in increased levels of platelet precursors in the blood and bone marrow.
  • Sometimes the bone marrow is just not up to the job, since it too may be damaged because of the CLL and just not able to make up the deficit of platelets.
  • A third possible cause for low platelets is chemotherapy. When you undergo therapy to control CLL, the debris created by the cancer cells getting killed is often carted away by platelets, and in the process platelets get chewed up as well.

Immune thrombocytopenia is different from all these three causes described above.

Here the problem is one of killer cells of the immune system going after platelets and hunting them down. Macrophages and T-cells are among the most effective killers that are normally very important in protecting us from various bugs that invade our bodies. In the case of autoimmune diseases such as AIHA and ITP, the very cells that are supposed to protect us get confused between friend and foe, they are no longer able to tell the difference between “self” and “non-self”.

The following is a check list for what is needed for a diagnosis of ITP in CLL patients:

  1. Rapid and quick fall in platelet counts – in a matter of less than two weeks.
  2. Platelet counts dropping by more than 50% from previous value within a two week period.
  3. Platelet count dropping below 50K.
  4. Normal levels of platelet precursors (“megakaryocytes”) in the bone marrow biopsy.
  5. Spleen must not be massively swollen. Minor swelling of the spleen does not matter.
  6. No chemotherapy in the preceding month.

Roughly 4-5% of CLL patients can develop ITP.

Patients with unmutated IgVH seem to be more at risk of developing ITP than those with the mutated (good) IgVH gene.

ITP complicates an already complicated situation for CLL patients, and it is an independent prognostic indicator for poorer survival. An explanation for shorter survival of ITP patients might be linked to the fact that immune suppressive treatments (such as steroids) are typically used to treat ITP, and this leaves patients even more vulnerable to opportunistic infections of all sorts.

(Source: Chaya Venkat, CLL Topics)

AIHA: Autoimmune haemolytic anaemia

AIHA is a condition in which red blood cells are destroyed and removed from the bloodstream before their normal lifespan is over.

CLL, or treatment for CLL, can raise your risk for AIHA and cause a big drop in red cell production in your body .

The most common symptom of all types of anemia is fatigue (tiredness). Fatigue occurs because your body doesn’t have enough red blood cells to carry oxygen to its various parts. A low red blood cell count also can cause shortness of breath, dizziness, headache, coldness in your hands and feet, pale skin, and chest pain. Other symptoms can include Jaundice, Leg Ulcers and Pain in the Upper Abdomen.

AIHA can lead to many health problems, such as these but can also include pain, irregular heartbeats called arrhythmias, an enlarged heart, and heart failure.

Treatment and outlook will depend on a number of factors such as how severe it is. The condition can develop suddenly or slowly. Symptoms can range from mild to severe.

Treatments for AIHA include blood transfusions, medicines, plasmapheresis, surgery, and blood and marrow stem cell transplants.

People who have mild AIHA may not need treatment, as long as the condition doesn’t worsen. People who have severe AIHA usually need ongoing treatment. Severe AIHA can be fatal if it’s not properly treated.

Richter Transformation

In a very small number of people (c.3-5%) with CLL it can transform into an aggressive lymphoma called a “Richter transformation” or “large cell transformation.” 

This transformation is significantly more common in IgHv-unmutated CLL (see Symptoms and Diagnosis)

Symptoms may include significantly enlarged lymph nodes, high temperatures and weight loss. Tumours may also develop in places other than the lymph nodes.

It is treated with aggressive chemotherapy and reduced-intensity allogeneic transplantation if feasible.

However unless a Richter transformation is diagnosed before treatment for CLL the prognosis is generally poor.

Infections & viruses

As CLL affects the immune system, CLL patients may be at a higher risk for due to their disease from infections or viruses.

CLL expert, Dr. William Wierda from MD Anderson Cancer Center in Houston discusses this and also provides advice to patients for monitoring symptoms and when to alert their doctor.

Watch his video here: What Is the Relationship Between CLL and Infections?

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