If the day comes that we have the much sought after “cure for cancer,” it will undoubtedly take the form of tens, hundreds or even thousands of distinct cures for various types of cancer. Even a relatively specific category such as blood cancers, can be divided into leukemia, lymphoma, and myeloma, which between them contain dozens of sub-types, each of which can present differently in patients and may require substantially different treatments.

Indeed, there are types of leukemia like chronic lymphocytic leukemia (CLL), which is treated as a lymphoma despite the name. “Leukemia is just a basket term that states that there have been cancer cells detected in the bloodstream,” explains Dr. John Kuruvilla of Princess Margaret Hospital. “It’s a bit of an arbitrary definition, just based on where you can find the disease typically. A lymphoma can be a leukemia if it’s in the blood.”

The following articles will look at indolent  CLL, which share many similarities despite their distinct classifications.

Understanding Chronic Lymphocytic Leukemia

Many people think of leukemia as a disease that primarily affects children. Chronic Lymphocytic Leukemia in particular primarily affects older people, in their early seventies on average. In 2010, 2,195 Canadians were diagnosed with chronic lymphocytic leukemia. CLL is similar to indolent non-Hodgkin lymphoma in many ways. CLL is actually considered to be the same underlying disease as small lymphocytic lymphoma, albeit with a different presentation and is generally treated with similar principles as indolent NHL. Like indolent NHL, CLL is often asymptomatic. In fact, in many patients it is first discovered as the result of a routine blood test showing an abnormally high count of a particular type of white blood cell.  

“The aging demographic has made 72 a young senior.”

The treatment plan likewise tends towards a watchful waiting approach, with the most substantial treatments being delayed as long as patients have no symptoms. In CLL, however, the reason for doing so is even more pronounced. “Because patients with CLL tend to be older, they may have other medical conditions like high blood pressure, diabetes, heart disease,” explains Markowitz. “So they may not be able to manage some of the therapies that are available. Fortunately, the newer therapies tend to be less invasive and have fewer side effects.”

Canadians living longer means more focus on diseases of the elderly

At the same time, older patients are increasingly looking further and further ahead when considering their treatment plans. “The aging demographic has made 72 a young senior,” says Markowitz. “Patients with CLL are aware of the fact that they may require several lines of therapies as each therapy is only effective for a certain period of time.  Once the therapy is no longer effective, another treatment option must be found. The new and emerging therapies provide new hope for the 72-year-old patient for years, even decades of quality life.” 

The good news is that effective new treatment options for CLL have been appearing very rapidly in recent years. Perhaps the most promising line of research is in the developing field of immuno-oncology, where immune system antibodies, bone marrow transplants, and smart small-molecule drugs are used to prompt the immune system to attack the cancer cells. These targeted techniques have shown remarkable promise as treatments for CLL and have become standard of care therapies in CLL and other lymphomas as well as some solid tumours.

In all, the prognosis for CLL patients is dramatically more positive than it was a few short years ago. “There has been a big transformation over the last five years, with multiple studies showing that you can increase survival in a way that is quite powerful,” says Dr. Kuruvilla.

So the message is one of reassurance and hope for those suffering from lymphoma and leukemia, and their families: reassurance that the current treatments are often able to provide decades of full life after diagnosis, frequently extending into the patients’ 90s, and hope that new treatments on the horizon may soon provide even better results, particularly for those diagnosed in their 50s, 60s and early 70s.