Health Complications of Chronic Lymphocytic Leukemia (CLL)

In chronic lymphocytic leukemia (CLL), a person’s bone marrow makes too many lymphocytes, a type of white blood cell.

The majority of people who have CLL live for many years, according to the American Cancer Society. While that’s certainly good news, it’s possible that complications may crop up if you’ve been diagnosed with this type of blood and bone marrow cancer.

The National Cancer Institute (NCI) defines a complication as: “a medical problem that occurs during a disease or after a procedure or treatment.” Complications associated with CLL can arise from the cancer itself or the therapies that are used, notes the Leukemia & Lymphoma Society.

While some complications can be mild, others can be serious and even life-threatening, according to CLL Society. Here are some common health issues associated with CLL.

Possible Complications of CLL

When CLL is in its early stages, some people with the disease don’t notice any signs or symptoms, explains the Mayo Clinic. But you may develop unwanted symptoms if the cancer progresses or if you undergo certain treatments.

Infections

People with CLL don’t have enough healthy white blood cells, which puts them at risk for bacterial, fungal, or viral infections, says the Cleveland Clinic.

Your doctor might recommend that you take immunoglobulin infusions to protect against infections, according to the Mayo Clinic. Additionally, the Leukemia & Lymphoma Society says that people with CLL may want to get vaccinated for infectious illnesses, such as pneumococcal pneumonia and the flu. CLL patients should not receive live vaccines, because of the risk of infection.

Richter’s Syndrome

According to the Leukemia & Lymphoma Society, for about 2 to 10 percent of patients with CLL, the disease changes into a more aggressive form of cancer, such as diffuse large-B cell lymphoma. This phenomenon is sometimes called Richter’s syndrome or Richter transformation.

People with Richter’s syndrome may develop symptoms suddenly and rapidly. According to Cancer Research UK, some signs include:

• Sudden lymph node swelling
• Fever
• Night sweats
• Weight loss
• Abdominal pain

If you develop a more aggressive cancer, your doctor will likely alter your treatment plan to better target the disease.

Anemia

If you have CLL, you’re more likely to develop anemia because you don’t have enough red blood cells to carry oxygen through your body. According to the Cleveland Clinic, signs of anemia include:

• Fatigue or weakness
• Cold hands and feet
• Shortness of breath
• Light-headedness or dizziness
• Fast or irregular heartbeat
• A swooshing sound in your ears
• Headache
• Chest pain
• Pale or yellow skin

Immune System Problems

People with CLL can develop autoimmune problems, which prompt their immune system to mistakenly attack healthy cells. According to the Mayo Clinic, some autoimmune complications associated with CLL include:

• Autoimmune hemolytic anemia The body mistakes red blood cells for foreign and attacks them.
• Autoimmune thrombocytopenia Disease-fighting cells attack platelets (blood cells that help form clots to stop bleeding).

Secondary Cancers

The Leukemia & Lymphoma Society explains that if you have CLL, you’re also more likely to develop other cancers, such as:

• Skin cancers, including melanoma and non-melanoma skin cancer
• Lung cancer
• Gastrointestinal cancer
• Acute myeloid leukemia (AML)
• Breast cancer
• Prostate cancer
• Bladder cancer
• Kidney cancer
• Head and neck cancers

This increased risk of secondary cancers may be due to immune function irregularities in people with CLL or the treatments patients receive, says the Leukemia & Lymphoma Society.

Joint or Bone Pain

CLL can sometimes trigger joint or bone pain. Leukaemia Care, a leukemia charity in the United Kingdom, explains that these aches happen if too many cancer cells in the bone marrow put pressure on nerves, or if the cells collect inside a joint. Pain can also result as a side effect of certain medicines.

According to the Leukemia & Lymphoma Society, bone pain is usually felt in the long bones of the arms and legs or in the ribs or rib cage. Joint pain typically affects larger joints, such as those in the hips and shoulders.

Rash and Skin Lesions

Rashes and skin spots can be complications of CLL. A study published in the International Journal of Hematology in October 2020 found that about 25 percent of patients with CLL experienced skin lesions. While some of these lesions are secondary cancers, other skin changes may be triggered by infections or reactions to certain irritants or medications. Additionally, CLL may cause you to bruise or bleed easily. Bleeding can manifest as petechiae: small pinpoints of dark spots under the skin, according to the NCI.

Enlarged Spleen

Your spleen is an organ in the upper left side of your abdomen that helps filter your blood. With CLL, a person’s spleen can accumulate too many abnormal cells, according to Cancer Research UK. This can prompt the spleen to enlarge, which may cause pain or discomfort. Doctors may recommend surgery to remove the spleen if it becomes too big and causes problems.

Kidney Failure

Some people with CLL develop kidney disease or kidney failure. A study published in the journal Blood found that about 1 in 13 patients with CLL had poor kidney function at the time of diagnosis, and an additional 16 percent developed poor kidney function during the course of the disease. Other research, published in the Clinical Kidney Journal in October 2018, showed that kidney disease impacted survival in people with CLL and was associated with worse outcomes.

According to the National Kidney Foundation, some signs of kidney disease include:

• Feeling tired
• Trouble concentrating
• Difficulties sleeping
• Dry or itchy skin
• Frequent urination
• Blood or foam in the urine
• Puffiness around the eyes
• Swollen feet or ankles
• Poor appetite
• Muscle cramping

Leukostasis

Leukostasis is a serious condition that occurs when white blood cell counts get too high, according to Critical Care Secrets. While it’s more common in acute leukemias, people with CLL may develop leukostasis, per a study in the October 2021 American Journal of Clinical Pathology.

Symptoms of leukostasis may include:

• Confusion
• Vision changes
• Headache
• Dizziness
• Ringing in the ears
• Balance issues
• Drowsiness
• Seizures or coma

How to Cope With Complications

If you have CLL, it’s important to tell your doctor about all the symptoms you experience. Your health provider can devise a treatment plan to target specific complications.

While there’s no surefire way to prevent complications, a healthy lifestyle will help you live better with CLL. The Leukemia & Lymphoma Society makes the following recommendations.

• Eat a healthy diet that includes plenty of fruits and vegetables.
• Exercise daily.
• Get 7 to 9 hours of sleep per day.
• Avoid alcohol and tobacco products.
• Drink enough fluids.
• Manage stress.