MARYANN BIRD: Welcome to our webcast. I'm Maryann Bird. Chronic lymphocytic leukemia or CLL accounts for 25% of all leukemias in the U.S., most common in adults over 50. It affects certain white blood cells called lymphocytes with serious consequences for the body's immune system.
Joining me to discuss CLL and how it's treated is Dr. John Hainsworth of the Sarah Cannon Cancer Center here in Nashville. Dr. Hainsworth, thank you for joining us.
Doctor, what is chronic lymphocytic leukemia?
JOHN D. HAINSWORTH, MD: CLL is one kind of leukemia that's actually the most common adult leukemia in this country. It is different than the other leukemias in that it really is a chronic disease. Patients can live for quite awhile. It's a malignancy of lymphocytes of a certain type of lymphocyte called a "B" lymphocyte. And these cells are normally in the human body to fight infection. They're the cells that produce antibodies against infection.
MARYANN BIRD: How does CLL differ from other blood cancers like chronic myeloid leukemia and non-Hodgkin's lymphoma?
JOHN D. HAINSWORTH, MD: In general, these different hematologic cancers are derived from different cells.
MARYANN BIRD: What causes CLL? Do we know?
JOHN D. HAINSWORTH, MD: We don't know what causes it. It's a disease that happens more frequently with increasing age. This is the only leukemia that's actually the most common in elderly patients. It's uncommon in patients younger than 50 years old.
MARYANN BIRD: What exactly happens when patients get CLL?
JOHN D. HAINSWORTH, MD: CLL, like any kind of cancer, involves a proliferation -- an abnormal proliferation of the cell that's the cancer cell. But in general, the big problems in this kind of cancer come when the bone marrow gets too full of these lymphocytes, and they start to affect the bone marrow's ability to do its normal functions, which are to produce other blood cells.
MARYANN BIRD: What are the signs or symptoms of this disease?
JOHN D. HAINSWORTH, MD: This is a disease that probably presents in one of three major ways. In this country, probably the most common way that people get diagnosed is that they go to their doctor for something else. And on a blood test, they're found to have a high white blood count level. And that leads to other tests, and then they get diagnosed. So often they're asymptomatic.
The second most common is probably that they feel some enlarged lymph nodes. And often that's fairly diffuse. They can feel them in the neck, under the arms, in the groin.
The third way -- and this is also fairly common -- is that they develop fatigue. The fatigue is basically from anemia, and that's -- that's as a result of the bone marrow infiltration that I mentioned before.
MARYANN BIRD: Is there a cure for CLL?
JOHN D. HAINSWORTH, MD: This is a leukemia that is not curable at present. On the other hand, it's one that many people who have it don't end up dying from it either. They have it and it's chronic and they live with it and then die from something else.
MARYANN BIRD: Briefly, what are the treatment options for patients who have CLL?
JOHN D. HAINSWORTH, MD: Some patients, actually, the best treatment option initially, if they're asymptomatic and are feeling fine, is actually not to treat them. So this is one kind of leukemia that often patients can be observed. When symptoms occur, that's when treatments are begun.
And typically, treatments have been with relatively mild chemotherapy drugs, often oral drugs, to put a patient in remission. They can stay in remission for awhile and off treatment. And then something -- and then the white count starts to go up or symptoms. They get another treatment, get back into remission, etc. And this can go on for several years where they get different treatments.
MARYANN BIRD: What cutting-edge therapies are there for CLL? What's new on the horizon?
JOHN D. HAINSWORTH, MD: In CLL, there are several new what are called "targeted" therapies. Actually the two that are out there right now are antibodies, and they weren't available before and actually are highly active against CLL. The way these drugs work -- rather than the chemotherapy drugs which basically are fairly non-specific cellular poisons, and that's how they kill cells. These targeted drugs go directly to the abnormal B-lymphocytes that are involved in CLL and then kill those cells once they get there.
MARYANN BIRD: What about using the cutting edge therapies with the traditional therapies?
JOHN D. HAINSWORTH, MD: The new agents that -- the monoclonal antibodies that I just mentioned -- are really new enough that their place in CLL has not been entirely defined yet. The two antibodies that are out recently in the last two or three years are Rituxan and Campath. They have been used by themselves but now probably the real interesting and exciting thing is that they're being used earlier in treatment, often in conjunction with our more standard chemotherapy. And already, using these antibodies plus chemotherapy have been able to give higher complete response rates in these patients.
MARYANN BIRD: How about bone marrow or stem cell transplantation?
JOHN D. HAINSWORTH, MD: Bone marrow transplants are high-dose chemotherapy with support with stem cells has not really been that useful, and I'd say probably will not play a major role in CLL in the future. Part of this is due to the fact that this is an elderly population. And that kind of treatment approach with -- has a lot of toxicity and a lot of side effects.
MARYANN BIRD: Does the stage of a patient's disease impact his or her treatment?
JOHN D. HAINSWORTH, MD: The stage of disease in CLL is important but mostly with respect to making the decision of whether to treat the patient or not.
MARYANN BIRD: I imagine some of your patients have a hard time to being told to watch and wait instead of seeking treatment.
JOHN D. HAINSWORTH, MD: That's true. This is one of the few cancers for which that is a reasonable option. And I think people are uncomfortable with that once they find out they have a cancer. It's difficult to convince people not to have treatment originally. But I think it's mostly a matter of just talking to them and educating them about this particular type of cancer.
MARYANN BIRD: Dr. Hainsworth, thank you very much for joining us today. And thank you for joining us on our webcast. I'm Maryann Bird.