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Chronic lymphocytic leukaemia (CLL) and Small lymphocytic lymphoma (SLL)

Chronic lymphocytic leukaemia (CLL) and small lymphocytic lymphoma (SLL) are lymphomas that affect mature B cells. They affect men and women equally and are rare in children. CLL accounts for around 15% and SLL accounts for 4-5% of all NHL cases. CLL and SLL are essentially the same disease, the only difference being where the cancer primarily occurs. When most of the cancer cells are located in the bloodstream and the bone marrow, the disease is referred to as CLL, although the lymph nodes and spleen are often involved. When the cancer cells are located mostly in the lymph nodes, the disease is called SLL.

CLL/SLL tends to be an indolent (slow-growing) cancer; however, over time, it can progress to a more aggressive type of lymphoma. Common signs of disease include a swelling of the liver and spleen and enlargement of the lymph nodes in the neck, underarm, stomach, or groin. Other symptoms of CLL/SLL can include fatigue, shortness of breath, anaemia, bruising, night sweats, weight loss, and frequent infections. Often, people with CLL/SLL have no obvious symptoms of the disease at diagnosis. Approximately one-third of all CLL/SLL patients will live for years without symptoms.

What are the symptoms?

Symptoms include swollen lymph nodes and an enlarged spleen (splenomegaly), which can cause a mass under the left ribcage, fullness in the abdomen and weight loss. Fatigue, recurrent minor infections or bleeding episodes may also be experienced.

SLL is usually diagnosed by lymph node biopsy. A bone marrow biopsy may be performed if there is minor lymph node involvement and reduced blood cell numbers.

How is it treated?

Initial treatment is often Watch and Wait. Some patients may never require therapy, whilst others develop symptoms of advancing disease and require treatment. Combination chemotherapy with a monoclonal antibody as well as targeted therapies are being used for the treatment of CLL/SLL.

Younger patients with this cancer may also be candidates for a stem cell transplant if required.

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