Chronic Lymphocytic Leukemia is a disease in which lymphocytes grow uncontrolled. These cells may cause swelling of the lymph nodes (such as under the armpit or groin) or decreases of the red blood cell count or platelets. Since red cells carry oxygen and nutrients to the body, patients may feel extreme fatigue. Platelets are part of the clotting system. As the CLL progresses and platelets fall, patients may experience bleeding.

The prognosis for many patients with CLL can be quite good. If the disease is limited to only an elevation of lymphocyte counts, or causes only lymph node swelling survival rates can exceed 5-10 years in most patients. However, if the disease causes the red blood cell count or platelet counts to fall (so called stage III or IV disease) the survival rates decrease dramatically to 2-3 years.

Treatment of CLL varies greatly depending on the aggressiveness and stage of the disease. Minimal treatment (sometimes none) is common in early disease. However as the disease progresses chemotherapy may be necessary. Medications such as chlorambucil, fludarabine, 2-cda, and combination chemotherapy (cyclophosphamide-adriamycin-vincrisitine-prednisone) may be used.

Transplantation Therapy in CLL

The experience with transplantation in CLL is quite limited. Small series in patients with very advanced disease have noted responses. However, since most patients with CLL are elderly the use of aggressive allogeneic transplantation has been hampered.

The Adult Stem Cell- Bone Marrow Transplant Program of Hackensack University Medical Center has active transplant treatment protocols for Chronic Lymphocytic Leukemia. For more information on this treatment or to schedule an appointment call (201) 996-5849.

ALLOGENEIC TRANSPLANT OPTIONS

Since many patients with CLL are older, transplantation therapy has often been felt to contain excessive risks. In an attempt to reduce the side-effects of this therapy, the Hackensack University Adult Transplant Program has recently begun a new transplant protocol using low-dose (sub-myeloablative) treatment in combination with Tissue-matched (HLA matched) brother/sister bone marrow. This new treatment attempts to capitalize on the "Graft-versus-Tumor Effect" without subjecting patients to the toxicities of high-dose chemotherapy. For more information on this new treatment, which may be appropriate for older patients, call (201) 996-5849.

For younger patients with Tissue-matched (HLA-matched) brother/sister bone marrow donors allogeneic transplantation treatment protocols may be appropriate. One trial uses high-dose cyclophosphamide combined with either total body irradiation or high-dose busulfan. Following this aggressive conditioning therapy, bone marrow (or peripheral blood stem cells) from an HLA-matched donor is infused. Graft-versus-host disease prevention is accomplished with combinations of tacrolimus and methotrexate. This very aggressive curative treatment requires a one-month hospitalization.

UNRELATED TRANSPLANT TREATMENT OPTIONS

For patients lacking a family member marrow donor, the Hackensack University Medical Center Transplant Programs are participating in several unrelated transplant protocols.

The National Marrow Donor Program has enlisted over 3 million volunteer bone marrow donors. If an HLA matched unrelated donor can be located, a transplant using high-dose cyclophosphamide and total body irradiation can be performed.

Hackensack University Medical Center is also participating in a multicenter trial evaluating the use of expanded Cord Blood Cells in the treatment of cancers and blood diseases. This trial also extends the treatment options for patients without HLA Matched relative donors. For more information click here and also review ex-vivo expansion in the stem cell laboratory section.

AUTOLOGOUS TRANSPLANT OPTIONS

Autologous transplant options are under development. For more information on autologous transplant options call (201) 996-5849.

NON-TRANSPLANT OPTIONS

The physicians at the Northern New Jersey Cancer Center are experienced in the diagnosis and treatment of this disease. Active research studies on CLL include (1) Phase II trial of fludarabine and cyclophophosphamide in previously untreated patients, and (2) Phase III study of PSC-833 and VAD in resistant or relapsing disease. For more information on these trials call (201) 996-5900.