Chronic Lymphocytic Leukemia (CLL) can potentially lead to anemia. Key points to understand.

Chronic Lymphocytic Leukemia (CLL) can potentially lead to anemia. Key points to understand.

Chronic Lymphocytic Leukemia (CLL) is the most common form of leukemia in adults, affecting cells that mature into lymphocytes. According to the American Cancer Society, there will be around 22,880 new cases of CLL in the United States in 2024.

CLL is twice as common in males than females and typically occurs in older people, being rare in people below age 40 years. One of the complications associated with CLL is anemia, a condition of reduced red blood cells (RBCs) or low hemoglobin within these cells.

Understanding Anemia in CLL

Anemia in CLL can be caused by various factors. The disease itself can interfere with the normal production of RBCs in the bone marrow. Additionally, some treatments for CLL, such as chemotherapy agents, can result in anemia due to bone marrow suppression. In about 25% of people with CLL, the immune system cells attack normal RBCs, causing a condition called autoimmune hemolytic anemia (AHA).

Symptoms of Anemia

People with anemia may experience symptoms such as weakness, fatigue, dizziness, chest pain, fast or irregular heartbeat, shortness of breath, cold hands and feet, pale skin, and unexplained tiredness.

Diagnosing Anemia in CLL

In the diagnosis of CLL-related anemia, a complete blood count (CBC) is performed to assess the relative numbers of RBCs and other types of blood cells. If AHA is suspected, a Coombs test or direct antiglobulin test (DAT) may be requested to check for the presence of antibodies attacking RBCs.

Treating Anemia in CLL

Treatment for CLL-related anemia focuses on managing the underlying CLL and alleviating anemia symptoms. Common treatments include chemotherapy and chemo-immunotherapy, immunotherapy, targeted drug therapies, supportive treatments like blood transfusions and erythropoiesis-stimulating agents (ESAs), and in specific cases, splenectomy (surgical removal of the spleen).

Chemotherapy and chemo-immunotherapy, such as FCR (fludarabine, cyclophosphamide, rituximab), are used to reduce leukemia cells that interfere with normal blood cell production. Immunotherapy, including monoclonal antibodies targeting CLL cells, can improve blood counts by reducing cancer burden. Targeted drug therapies, such as Bruton’s tyrosine kinase inhibitors (acalabrutinib, zanubrutinib) or Bcl-2 inhibitors (venetoclax), selectively kill leukemia cells and often improve anemia.

ESAs stimulate the bone marrow to produce more RBCs and are more effective than blood transfusions in maintaining consistent hemoglobin levels. In severe anemia cases, blood transfusions may be necessary. Splenectomy may be done to reduce anemia caused by spleen-related destruction of RBCs.

Emerging therapies such as CAR T cell therapy are promising for refractory or aggressive CLL and can lead to improvement in anemia by controlling the leukemia.

Treatment Considerations

The choice of treatment depends on disease stage, patient health, and symptoms related to anemia. Often, a combination of these approaches is used to control CLL and improve blood counts. A doctor will evaluate a suitable treatment plan based on the person's age, medical history, and ongoing cancer therapies.

With early diagnosis and treatment, it is possible to manage CLL-related anemia effectively. For more research-backed information and in-depth resources on leukemia, leukemia resources are available.

1. Chronic Lymphocytic Leukemia (CLL) can sometimes lead to deficiency anemias, a medical condition characterized by low red blood cells (RBCs) or hemoglobin within these cells.
2. To diagnose CLL-related anemia, doctors may perform a complete blood count (CBC) and, if autoimmune hemolytic anemia (AHA) is suspected, request a Coombs test or direct antiglobulin test (DAT) to check for the presence of antibodies attacking RBCs.
3. In chronic illnesses like CLL, when anemia arises due to several factors including the disease itself, treatments, or the immune system attacking RBCs, potential treatments may involve chemotherapy, targeted drug therapies, supportive treatments like blood transfusions or erythropoiesis-stimulating agents (ESAs), immunotherapy, and in specific cases, splenectomy.

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