诊断
Diagnosis of chronic lymphocytic leukemia often begins with a physical exam. The exam checks for swollen lymph nodes in the neck, underarms and groin and an enlarged spleen. Other tests and procedures include blood tests, imaging tests and taking a sample of tissue for lab testing.
血液检测
用于诊断慢性淋巴细胞白血病的检查和医疗程序包括血液检测，目的是：
其他检查
在某些情况下，医生可能会安排额外的检查和相关程序来帮助诊断，例如：
- 检查白血病细胞，以寻找可能会影响您的预后的细胞表征
- 骨髓活检和穿刺
- 成像检查，比如计算机断层成像（CT 扫描）和正电子发射断层成像（PET 扫描）
治疗
您的慢性淋巴细胞白血病治疗选择取决于几个因素，例如您的癌症分期、您是否已出现体征和症状、您的总体健康状况以及您的偏好。
可能不需要立即进行治疗
如果慢性淋巴细胞白血病没有引起症状，也没有表现出恶化的迹象，可能不需要立即治疗。研究表明，及早治疗并不能延长早期慢性淋巴细胞白血病患者的生命。
在您需要治疗之前，医生不会让您经历治疗的潜在副作用和并发症，而是仔细监测您的病情，待到白血病发生进展时再执行治疗方案。
医生会为您制定一个检查时间表。您可能每隔几个月都需要与您的医生约诊，进行血液检测以监测您的病情。
中晚期癌症的治疗
如果医生判断您的慢性淋巴细胞白血病需要治疗，则治疗选项可能包括：
这些治疗方法可以单独使用，也可以互相结合使用。
支持性护理
医生会定期与您会面，以监测您可能出现的任何并发症。支持性护理措施可帮助预防或缓解任何体征或症状。
支持性护理可能包括：
- 癌症筛查。医生会评估您患其他类型的癌症的风险，可能建议进行筛查，以寻找其他癌症的体征。
- 预防感染的疫苗接种。医生可能会建议您接种某些疫苗，以降低感染风险，例如感染性肺炎和流行性感冒。
- 监测其他健康问题。医生可能会建议进行定期检查，以监测您在慢性淋巴细胞白血病治疗期间和治疗后的健康状况。
Immunotherapy
Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.
Immunotherapy may be combined with chemotherapy to treat chronic lymphocytic leukemia. Immunotherapy also may be used for relapsed or refractory chronic lymphocytic leukemia.
Side effects of immunotherapy may include fever, chills, weakness, dizziness, aches, upset stomach and vomiting. Rarely, some immunotherapy treatments can cause an allergic reaction.
Bone marrow transplant
A bone marrow transplant, also called a bone marrow stem cell transplant, involves putting healthy bone marrow stem cells into the body. These cells replace cells hurt by chemotherapy and other treatments. Stem cells can come from your own body, called an autologous transplant. Stem cells also can come from a donor, called an allogeneic transplant.
As new and more-effective treatments have been developed, bone marrow transplant has become less common for treating chronic lymphocytic leukemia. However, an allogeneic bone marrow transplant may be a treatment option for some people with relapsed or refractory chronic lymphocytic leukemia.
Short-term side effects of a bone marrow transplant may include upset stomach, vomiting and not feeling hungry. They also may include fatigue, mouth sores, hair loss and skin reactions. Long-term side effects may include infertility, secondary cancers, organ damage, weakness in the bones or muscles, and cataracts.
CAR-T cell therapy
Chimeric antigen receptor (CAR)-T cell therapy trains the immune system cells to fight leukemia. This treatment begins with removing some white blood cells, including T cells, from the blood.
The cells are sent to a lab. In the lab, the cells are treated so that they make special receptors. The receptors help the cells recognize a marker on the surface of the leukemia cells. Then the cells go back into the body. They find and destroy leukemia cells.
CAR-T cell therapy may be an option for some people with refractory or relapsed CLL. CAR-T cell therapy may only be used after at least two other treatments have been tried.
Side effects of CAR-T cell therapy may include fever, upset stomach, headache and confusion. They also may include dizziness, rash, rapid heartbeat, trouble breathing and low blood pressure.
Radiation
Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources. During radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points in your body.
For chronic lymphocytic leukemia, radiation therapy may only be used to ease symptoms and improve quality of life.
Radiation therapy side effects include fatigue and skin irritation at the site where the radiation is aimed. Other side effects depend on where the radiation is aimed. Radiation to the neck can cause dry mouth and damage the thyroid. Radiation to the chest can damage the heart and lungs.
Clinical trial
Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask your healthcare team if you might be able to be in a clinical trial.
Monitoring after treatment
After treatment is complete, you may have frequent follow-up appointments to see if the cancer has come back, known as a relapse. You may have repeat blood and imaging tests to check for a relapse.
Treatment complications
Treatments for chronic lymphocytic leukemia may have complications, including:
- Bone marrow suppression. When the bone marrow is suppressed, it can't produce enough blood cells, including white blood cells. White blood cells help fight infections. With a lower amount of white blood cells, you are at a higher risk of infections.
- Febrile neutropenia. Febrile neutropenia is a serious condition that can happen in people being treated for cancer. Febrile means having a fever. Neutropenia means having a low number of neutrophils, a type of white blood cell that helps fight infections. In febrile neutropenia, the body is trying to fight an infection but doesn't have enough neutrophils.
- Medicine toxicity. Some medicines used to treat cancer can be harmful to the body. They can cause organ damage and other issues. Whether a medicine is toxic depends on the type and how much you receive. There are many different medicine options. Your healthcare team can work with you to find the best medicines for you.
- Reactivating viruses. If you have had a viral infection in the past, such as hepatitis B or hepatitis C, some treatments can cause the virus to become active again. This can lead to liver inflammation, liver damage and other complications.
- Tumor lysis syndrome. Tumor lysis syndrome is a serious condition that can happen when cancer cells break down quickly after treatment or randomly. When these cells die, they release substances into the bloodstream that can overwhelm the body. This can lead to issues with the kidneys and other organs. You may take medicines to treat or prevent harmful side effects.
替代医学
尚未证明替代疗法可以治愈慢性淋巴细胞白血病。
应对疲劳的替代疗法
一些替代药物疗法有助于缓解疲劳，而疲劳是慢性淋巴细胞白血病患者通常会出现的症状。医生可以通过控制基础病因来治疗疲劳，但往往仅依靠药物进行治疗远远不够。您可以通过替代疗法缓解疲劳，比如：
与医生讨论您的治疗方案。医生可以与您一起制定有助您应对疲劳的计划。
妥善处理与支持
慢性淋巴细胞白血病通常是一种生长缓慢的癌症，可能无需治疗。尽管有些人可能将这种疾病称为“良性”癌症，但这并没有让患者更容易接受这一癌症诊断结果。
虽然您在确诊之初可能感到震惊和焦虑，但您最终会找到自己应对慢性淋巴细胞白血病的方式。在那之前，请尝试：
- 充分了解癌症的知识，以便对自己的护理做出决策。在每次就诊之前，写下要向医生咨询的问题，并在您当地的图书馆和互联网上查找相关信息。可靠的信息来源包括国家癌症研究所、美国癌症协会以及白血病和淋巴瘤协会。
- 向家人和朋友寻求支持。与家人和朋友保持联系，寻求支持。讨论您的诊断结果可能很困难，当您分享这些消息时，可能得到多种反应。不过，讨论您的诊断结果和传达您癌症的相关信息可能有所帮助。经常随之而来的援助，也会对您有所助益。
- 与其他癌症幸存者建立联系。不妨加入社区或网上的互助团体。由同样确诊的患者组成的互助组可以提供有用的信息、实用的技巧以及鼓励。
- 探索如何应对这种疾病难以摆脱和长期存在的难题。如果您患有慢性淋巴细胞白血病，可能需要接受持续检测，还需要长期关注您的白细胞计数量。尝试找到能够帮助您放松的活动，无论是瑜伽、运动还是园艺。当应对这种慢性病带来的情感挑战时，如果您需要帮助，请向咨询师、治疗师或社工咨询。
准备您的预约
如果有任何令您担忧的体征或症状，请先与家庭医生约诊。如果医生认为您可能患有慢性淋巴细胞白血病，可能会将您转诊给血液和骨髓疾病的医生（血液学家）。
由于就诊时间可能很短，而且通常要讨论很多信息，因此最好为就诊做好准备。以下信息可以帮助您做好准备，并了解医生可能会做什么。
您可以做些什么
- 了解就诊前的全部限制规定。当您预约时，询问是否需要提前做什么准备，例如限制您的饮食。
- 写下关键的个人信息，包括主要的压力或近期的生活变化。
- 列出您正在服用的所有药物、维生素或补充剂。
- 请家人或朋友陪同。有时很难记住在就诊过程中提供的全部信息。陪同您的人可能会记起您遗漏或遗忘的内容。
- 写下您要问医生的问题。
由于就诊时间有限，因此提前准备好问题清单有助于充分利用就诊时间。按重要性从高到低罗列问题，以免时间不够。有关慢性淋巴细胞白血病的一些基本问题包括：
- 我的检查结果意味着什么？
- 我是否需要立即接受治疗？
- 如果我现在不治疗，是否会限制我未来的治疗方案选择？
- 我还应接受其他治疗吗？
- 可以选择哪些治疗方案？
- 每种治疗的副作用有哪些？
- 对于我这类诊断患者，是否有强烈推荐的一种治疗方法？
- 治疗会对我的日常生活造成哪些影响？
- 我还有其他健康状况。我怎样才能同时管理好这些病症？
- 有没有我可以带走的手册或其他印刷材料？有哪些网站可推荐？
除准备要问的问题外，就诊期间，您还可以随时询问其他问题。
医生可能会做什么
您的医生可能会询问一些问题。请做好回答这些问题的准备，这样有利于更好地安排时间，去详细了解您所关注的任何方面。您的医生可能会问：
- 您第一次出现症状是在什么时候？
- 症状是持续存在还是偶尔出现？
- 您的症状有多严重？
- 有没有什么因素似乎会令您的症状好转？
- 有没有什么因素似乎会加重您的症状？