Are there different types of chronic lymphocytic leukemia? What cells are affected by chronic lymphocytic leukemia? chronic lymphocytic leukemia vs small lymphocytic lymphoma?

What cells are affected by CLL?

So CLL is a form of blood cancer where lymphocytes, which are cells that are part of the immune system overgrow meaning you have too many of those cells either
building up in lymph nodes or circulating in the blood, or often both. Those cells can accumulate to quite a level without causing problems in some cases. Many patients that I've known have had CLL have been told by the first doctor that checked blood work and saw very high levels of these cells that they've given the impression that this was something quite scary. And in many of those cases, my role is to reassure someone that actually you can live with more lymphocytes than the average person
and not always get sick from them. That being said, some people do get sick. There's there's a number of ways that as these lymphocytes grow and accumulate, they can suppress other cells that are needed. They can grow in the lymph nodes to the point that they actually become tumors
and can cause problems. And there's a lot of symptoms that some people will develop. And if someone does start to develop those kind of symptoms, then we need to start talking about treatment. The good news is we have a lot of really effective treatments for CLL
when they're needed. 

Are there different types of CLL?

Like with just about every cancer in humans, we've come a long way in terms of dividing it up into subcategories. Trying to understand what makes one case different from another. And the way we do that mostly is with genetics. So there are a few genetic tests that we run on CLL cells to look for changes that would put someone in a higher risk category, changes that we generally hope not to find. And and if we do find those, we may treat it a little more intensively than with other folks. But even patients
with more adverse risk genetics can still benefit a lot from treatment. And and so those different types of CLL are actually not that critical for most patients to be aware of. It makes some difference. And I think it is. It's definitely good practice for those tests to be run. So your doctor should know if you're in a higher risk group and you should be aware of that too. But most of the things that you'll learn about the disease and most of the treatments that you would consider taking would still apply regardless
of whether you have particular mutations or not. If you start reading about this, you may come across the term 17p. That refers to part of the 17th chromosome for some interesting reasons. It's a very common piece of DNA to lose in blood cancers and people that lose it or people to get a mutation in it, which is in a gene called tp53. And those individuals tend to have disease that grows a little faster and that doesn't respond to some of the some of the treatments. So a few years ago, it was actually really important to know if you were 17p deleted or tp53 mutated because there were older treatments that wouldn't be useful for you and we wouldn't even give. But as practices change, we've now decided that the newer treatments are actually better for everybody, and so we don't use those older ones anyway for the most part. So it's it's a rare circumstances, where it would really change your treatment. But I think it's still good to know about and, you know, it's a reasonable question to ask your doctor, “have I been tested for these things?” What's the difference between CLL and SLL? So this gets very confusing. So CLL is chronic lymphocytic leukemia. -emia refers to the blood. So this is malignant cells that are circulating. We can find them in any any tube of blood that we draw. SLL is small lymphocytic lymphoma. And an -oma is a word that means a growth or mass. So. So SLL is a disease of the lymph nodes. Where nodes enlarge, it's very common for people to feel lumps in their neck or under their arms or in their groin, and then we can find other ones deep in the body with imaging scans. So the question comes up, well, which one do I have?

Do I have leukemia or do I have lymphoma?

When one doctor said used one term and another used the other. But the fact is that they're the same disease in the ways
that matter in the biology of the cells and how they behave and how they grow, how they respond to treatments. We really think of them as the same thing. And in the medical literature it'll just say CLL/SLL as one entity. it is really a spectrum in terms of where we find the disease. Some people have quite a lot of it in the blood
and hardly any in lymph nodes. Others will have completely normal blood tests and but will have very large lymph nodes. And so CLL a more appropriate term for the former and SLL for the latter. And then there are people that are somewhere in the middle that have both and they almost become interchangeable.