Chronic Lymphocytic Leukemia

Chronic lymphocytic leukemia (CLL) is an abnormal proliferation of a particular type of white blood cells termed lymphocytes hence its name. ^[1] Moreover, the condition is chronic which means that it progresses slowly. ^[2] The onset is often insidious. ^[3]

Epidemiology

CLL is the most frequent form of leukemia occurring among adult individuals in the Western nations. The condition is atypical in Asian countries. There is male predilection and reports state that the incidence is higher in whites. The elder population seems to be the mostly affected with a median age of 72 years old. ^[3] The condition is also more seen in certain races like the Jewish people of Russian or East European descent. ^[1]

Causes

The exact cause is unknown. True familial cases are rare. ^[3] Experts could not establish the association of CLL to radiation, chemicals or viruses. ^[1]

Signs and Symptoms

Signs and symptoms develop gradually. These include enlarged lymph node, liver or spleen. The enlarged lymph nodes may be located in the neck, armpit or in the groin area. An enlarged liver may manifest as pain or discomfort in the upper right part of the abdomen while an enlarged spleen may manifest as pain or discomfort in the upper left side under the ribs. A person with CLL may lose appetite and experience fatigue. Paleness and persistent tiredness are common. The patient can experience excessive sweating especially at night, fever and recurrent infections. There can be easy bruising, easy bleeding and pinpoint rashes in the skin called petechiae. Unintentional weight loss is another nonspecific symptom of CLL. ^{[1] [3] [4]}

Diagnosis

Adequate medical history coupled with physical examination is required to suspect CLL. To make an accurate diagnosis, laboratory exams are needed such as complete blood count and bone marrow biopsy. Other tests include CT scan, immunoglobulin tests and flow cytometry tests. ^[1] To help predict the outlook or clinical course, chromosomal tests can be employed. ^[2]

Treatment

Patients in the early stages often do not need treatment. Medical intervention is only suggested for those whose disease has progressed or is causing significant symptoms. Chemotherapy drugs like fludarabine may be used. Depending on the case, transfusion of blood or blood component may be required. The only known curative therapy is transplant. ^{[1] [3]}

References:

1.      http://www.nlm.nih.gov/medlineplus/ency/article/000532.htm

2.      http://www.mayoclinic.com/health/chronic-lymphocytic-leukemia/DS00565

3.      http://emedicine.medscape.com/article/199313-overview#aw2aab6b2b2

4.      http://www.leukaemia.org.au/web/aboutdiseases/leukaemias_cll.php

Efficacy of Alternative and Other Treatments According to GRADE* Ranking:

Vitae Elixxir[1, 21, 22]:

Please note, this management does NOT treat the condition itself. It is proposed only as a weak supportive symptomatic support, and even then, has insufficient evidence to back up this claim at present. Warning: Possible side effects of Vitae Elixxir include diarrhoea, pain, and a general worsening of existing symptoms.

Recommendation: No recommendation (Available evidence does not support claims that vitae elixir helps to treat leukemia)

Grade of Evidence: very low quality of evidence

Rabdosia Rubescens (Dong Ling Cao, Oridonin, Isodon Rubescens) [1, 15, 16, 17, 18, 19, 20]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present.

Recommendation: weakly in favor (Laboratory studies show that rabdosia rubescens has anti-cancer activity, and may be helpful in the treatment of leukemia. However, more studies are needed)

Grade of Evidence: low quality of evidence

 * www.gradeworkinggroup.org

Pau D'Arco (Lapachol, Tabebuia Impetiginosa, Tabebuia Heptaphylla) [1, 14]:

Please note, this treatment has potentially serious side effects. Some of the chemicals in the plant are known to be toxic. High doses are known to cause liver and kidney. Even at low doses, chemicals in the plant may interfere with blood clotting, causing excess bleeding and anaemia. Pau D'Arco should be avoided, especially by pregnant or breastfeeding women.

Recommendation: Strongly against (There is insufficient evidence to support claims that Pau D'arco helps to treat leukemia. This, combined with its potentially harmful side effects if taken without supervision from a doctor or pharmacist gives enough reason to avoid this treatment.)

Grade of Evidence: very low quality of evidence

Mistletoe (Iscador, Viscum Album) [1, 9, 10, 11, 12, 13]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. WARNING: The mistletoe plant should NOT be eaten because it is poisonous. May cause seizures, coma and death. It should only be taken as a purified mistletoe extract, and only in recommended doses.

Recommendation: No recommendation (Studies on the effect of Mistletoe on Leukemia have yielded mixed, conflicting results. More research is needed.)

Grade of Evidence: low quality of evidence

Licorice (Glcyrhiz Gaba) [1, 5, 6, 7, 8]:

Please note, this management does NOT treat the condition itself. It may mildly help with some of the symptoms, and even then has insufficient evidence to back up this claim at present. Licorice has been shown to have potentially harmful side effects in people with high blood pressure, liver or kidney diseases)

Recommendation: Weakly in favor (Small studies and laboratory tests show that Licorice may help reduce tumor growth in leukemia, but more research is needed)

Grade of Evidence: low quality of evidence

Germanium (Germanium Sesquioxide, Vitamin O) [1, 2, 3, 4]:

WARNING: Germanium may cause permanent Kidney failure. Even organic supplements, though less toxic than inorganic supplements, have caused kidney and liver damage. NOT TO BE USED.

Recommendation: strongly against (Evidence shows that Germanium is not effective in treating Leukemia in any way, and is also toxic, causing severe kidney and liver damage.)

Grade of Evidence: moderate quality of evidence

* www.gradeworkinggroup.org