Read Time: 4 Min
Chronic Lymphocytic Leukemia (CLL) – A Simple Explanation for Patients
By
Mr. Zeeshan Fayaz .
Clinical Pharmacologist & Toxicology ,
Certified Mental Health Counselor ,
Member of American clinical Pharmacological Society ,
Member of Indian Pharmacological Society (IPS)
Chronic Lymphocytic Leukemia, commonly called CLL, is a type of blood cancer that mainly affects a kind of white blood cell called lymphocytes. These cells normally protect us from infections. In CLL, the body starts producing too many of these cells, and they do not work properly.
CLL usually progresses slowly, and many patients live for years with very good quality of life.
What CLL Means
In this condition:
The body makes extra lymphocytes, but they are weaker than normal.
These cells stay in the blood and bone marrow longer than they should.
Over time, they can build up and crowd out healthy blood cells.
Because of this, some patients may develop anemia, low platelets, or frequent infections.
What We See Under the Microscope
As part of the diagnosis, we often look at the patient’s blood smear under a microscope.
Below is what the images I observed indicate:
Image 1 – Peripheral Blood Smear
In this image, you can see:
Many small, round, purple lymphocytes packed densely.
These cells look very similar to each other.
Some cells appear broken or smudged – these are called “smudge cells”, very typical in CLL.
This pattern is classic for CLL and helps us confirm the diagnosis.
Image 2 – Dense Lymphocytic Field
The second image shows:
A very crowded field of lymphocytes, suggesting heavy involvement.
This is often seen when the blood or bone marrow gets filled with these CLL cells.
When bone marrow becomes full like this, it produces fewer normal cells, which is why some patients feel tired or bruise easily.
These microscopic findings support the diagnosis of Chronic Lymphocytic Leukemia.
Symptoms Patients May Notice
Not everyone has symptoms in the early stage, but some people may experience:
Persistent tiredness
Painless swelling of lymph nodes (neck, armpit, groin)
Losing weight without trying
Night sweats
Frequent infections
Feeling full quickly due to an enlarged spleen
If you notice any new symptoms, it’s important to tell your doctor.
How We Confirm the Diagnosis
To diagnose CLL, we combine:
Blood counts – showing increased lymphocytes
Blood smear – like the images above
Flow cytometry – confirms the type of lymphocyte
Genetic tests (FISH panel) – helps guide treatment
Physical examination – checking lymph nodes, spleen
These tests together give us a complete picture of your condition.
Do You Need Treatment Immediately?
Most patients do not need treatment when CLL is first discovered.
Instead, we follow a scientifically proven approach called “Watch and Wait”, which means:
We monitor your blood counts regularly
We check your symptoms
We start treatment only when it becomes necessary
Starting treatment too early does not improve outcomes, so monitoring is the safest and best approach for early-stage CLL.
When Treatment Is Needed
We consider treatment if:
Blood counts start dropping
Lymph nodes or spleen become very large
The number of abnormal lymphocytes rises rapidly
You develop symptoms like fever, weight loss, night sweats
Autoimmune issues occur (such as low red cells or platelets)
Treatment Options
Today, CLL treatment is highly advanced. Options include:
Targeted therapies (like ibrutinib, acalabrutinib, venetoclax)
These attack cancer cells without affecting most healthy cells.
Monoclonal antibodies (rituximab, obinutuzumab)
These help the immune system target CLL cells.
Chemo-immunotherapy (less common now)
Stem cell transplant (rare; for aggressive cases only)
Your treatment plan is personalized based on your tests and clinical findings.
Prognosis and Outlook
Many patients live long and healthy lives with CLL.
Modern medicines have changed the outlook dramatically and have made the disease very manageable.
Factors that help us understand your prognosis include:
Genetic changes
How quickly lymphocytes increase
Blood counts
Your overall health
Regular follow-up is essential so we can detect any changes early.
Final Words for Patients
CLL is a chronic condition, but with regular monitoring and timely treatment, it can be managed very effectively. The images above show typical findings of CLL and help us understand how your blood cells are behaving.
If you have any questions or concerns, always feel free to ask during your consultation. Understanding the disease helps you stay in control of your health.
Case studies available upon request.
Please provide information on how we can help you and we will be in touch to help meet your requirements.
