Chronic lymphocytic leukemia - Diagnosis and treatment (2022)


Blood tests

Tests and procedures used to diagnose chronic lymphocytic leukemia include blood tests designed to:

  • Count the number of cells in a blood sample. A complete blood count may be used to count the number of lymphocytes in a blood sample. A high number of B cells, one type of lymphocyte, may indicate chronic lymphocytic leukemia.
  • Determine the type of lymphocytes involved. A test called flow cytometry or immunophenotyping helps determine whether an increased number of lymphocytes is due to chronic lymphocytic leukemia, a different blood disorder or your body's reaction to another process, such as infection.

    If chronic lymphocytic leukemia is present, flow cytometry may also help analyze the leukemia cells for characteristics that help predict how aggressive the cells are.

  • Analyze lymphocytes for genetic changes. A test called fluorescence in situ hybridization (FISH) examines the chromosomes inside the cancerous lymphocytes to look for changes. Doctors sometimes use this information to determine your prognosis and help choose a treatment.

Other tests

In some cases, your doctor may order additional tests and procedures to aid in diagnosis, such as:

  • Tests of your leukemia cells that look for characteristics that could affect your prognosis
  • Bone marrow biopsy and aspiration
  • Imaging tests, such as computerized tomography (CT) and positron emission tomography (PET)


Once a diagnosis is confirmed, your doctor uses the information about your cancer to determine the stage of your chronic lymphocytic leukemia. The stage tells your doctor how aggressive your cancer is and how likely it is to get worse quickly.

Chronic lymphocytic leukemia stages can use letters or numbers. In general, the earliest stages of disease don't need to be treated right away. People with cancer in the later stages may consider beginning treatment immediately.

Care at Mayo Clinic

Our caring team of Mayo Clinic experts can help you with your chronic lymphocytic leukemia-related health concernsStart Here

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More Information

  • Chronic lymphocytic leukemia care at Mayo Clinic
  • Bone marrow biopsy
  • Complete blood count (CBC)
  • CT scan


Your treatment options for chronic lymphocytic leukemia depend on several factors, such as the stage of your cancer, whether you're experiencing signs and symptoms, your overall health, and your preferences.

Treatment may not be needed right away

If your chronic lymphocytic leukemia doesn't cause symptoms and doesn't show signs of getting worse, you may not need treatment right away. Studies have shown that early treatment doesn't extend lives for people with early-stage chronic lymphocytic leukemia.

Rather than put you through the potential side effects and complications of treatment before you need it, doctors carefully monitor your condition and reserve treatment for when your leukemia progresses.

Your doctor will plan a checkup schedule for you. You may meet with your doctor and have your blood tested every few months to monitor your condition.

Treatments for intermediate and advanced stages

If your doctor determines that your chronic lymphocytic leukemia requires treatment, your options may include:

  • Chemotherapy. Chemotherapy is a drug treatment that kills quickly growing cells, including cancer cells. Chemotherapy treatments can be administered through a vein or taken in pill form. Depending on your situation, your doctor may use a single chemotherapy drug or you may receive a combination of drugs.
  • Targeted drug therapy. Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
  • Immunotherapy. Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.
  • Bone marrow transplant. A bone marrow transplant, also known as a stem cell transplant, uses strong chemotherapy drugs to kill the stem cells in your bone marrow that are creating diseased lymphocytes. Then healthy adult blood stem cells from a donor are infused into your blood, where they travel to your bone marrow and begin making healthy blood cells.

    (Video) Diagnosis& Treatment of Chronic Lymphocytic Leukemia (CLL)

    As new and more-effective drug combinations have been developed, bone marrow transplant has become less common in treating chronic lymphocytic leukemia. Still, in certain situations this may be a treatment option.

Treatments may be used alone or in combination with each other.

Supportive care

Your doctor will meet with you regularly to monitor any complications you may experience. Supportive care measures may help prevent or relieve any signs or symptoms.

Supportive care may include:

  • Cancer screening. Your doctor will evaluate your risk of other types of cancer and may recommend screening to look for signs of other cancers.
  • Vaccinations to prevent infections. Your doctor may recommend certain vaccinations to reduce your risk of infections, such as pneumonia and influenza.
  • Monitoring for other health problems. Your doctor may recommend regular checkups to monitor your health during and after treatment for chronic lymphocytic leukemia.

More Information

  • Chronic lymphocytic leukemia care at Mayo Clinic
  • Bone marrow transplant
  • Chemotherapy

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(Video) Chronic Lymphocytic Leukemia (CLL) - Mayo Clinic

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Alternative medicine

No alternative treatments have been proved to cure chronic lymphocytic leukemia.

Alternative treatments for coping with fatigue

Some alternative medicine therapies may help you cope with fatigue, which is commonly experienced by people with chronic lymphocytic leukemia. Your doctor can treat fatigue by controlling the underlying causes, but often medications alone aren't enough. You may find relief through alternative therapies, such as:

  • Acupuncture
  • Exercise
  • Massage
  • Yoga

Talk to your doctor about your options. Together you can devise a plan to help you cope with fatigue.

Coping and support

Chronic lymphocytic leukemia is typically a slow-growing cancer that may not require treatment. While some people may refer to this as a "good" type of cancer, it doesn't really make receiving a cancer diagnosis any easier.

While you may initially be shocked and anxious about your diagnosis, you'll eventually find your own way of coping with chronic lymphocytic leukemia. Until then, try to:

  • Find out enough about your cancer to make decisions about your care. Write down questions to ask your doctor before each appointment and look for information in your local library and on the internet. Good sources include the National Cancer Institute, the American Cancer Society, and the Leukemia & Lymphoma Society.
  • Turn to family and friends for support. Stay connected to family and friends for support. It can be tough to talk about your diagnosis, and you'll likely get a range of reactions when you share the news. But talking about your diagnosis and passing along information about your cancer can help. So can the offers of help that often result.
  • Connect with other cancer survivors. Consider joining a support group, either in your community or on the internet. A support group of people with the same diagnosis can be a source of useful information, practical tips and encouragement.
  • Explore ways to cope with the nagging, chronic nature of the disease. If you have chronic lymphocytic leukemia, you'll likely face ongoing tests and ongoing worries about your white blood cell count. Try to find an activity that helps you relax, whether it's yoga, exercise or gardening. Talk to a counselor, therapist or social worker if you need help dealing with the emotional challenges of this chronic disease.

Preparing for your appointment

If you have any signs or symptoms that worry you, start by making an appointment with your family doctor. If your doctor determines that you may have chronic lymphocytic leukemia, you may be referred to a doctor who specializes in diseases of the blood and bone marrow (hematologist).

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Because appointments can be brief, and because there's often a lot of information to discuss, it's a good idea to be prepared. Here's some information to help you get ready and know what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you're taking.
  • Take a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may recall something that you missed or forgot.
  • Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For chronic lymphocytic leukemia, some basic questions include:

  • What do my test results mean?
  • Do I need treatment right away?
  • If I don't begin treatment right now, will that limit my treatment options in the future?
  • Should I undergo additional tests?
  • What are my treatment options?
  • What are the side effects associated with each treatment?
  • Is there one treatment that's strongly recommended for someone with my diagnosis?
  • How will treatment affect my daily life?
  • I have other health conditions. How can I best manage them together?
  • Are there any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions as they occur to you during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may allow time to cover other points you want to address. Your doctor may ask:

  • When did you first begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?

By Mayo Clinic Staff

Aug. 10, 2021


How is chronic lymphocytic leukemia diagnosed? ›

Blood tests

The main test used to help diagnose CLL is a type of blood test called a full blood count. This is where the number and appearance of the different blood cells in a sample of your blood are checked in a laboratory. An abnormally high number of unusual white blood cells (lymphocytes) can be a sign of CLL.

At what point does CLL require treatment? ›

Patients with chronic lymphocytic leukemia (chronic lymphoid leukemia, CLL) do not require drug therapy until they become symptomatic or display evidence of rapid progression of disease, as characterized by the following: Weight loss of more than 10% over 6 months.

How long can you live after CLL diagnosis? ›

The prognosis of patients with CLL varies widely at diagnosis. Some patients die rapidly, within 2-3 years of diagnosis, because of complications from CLL. Most patients live 5-10 years, with an initial course that is relatively benign but followed by a terminal, progressive, and resistant phase lasting 1-2 years.

Is CLL difficult to diagnose? ›

Chronic lymphocytic leukemia (CLL) is a type of cancer that affects lymphocytes. It can be challenging to detect CLL early, because it does not cause symptoms in its early stages. Lymphocytes are a type of white blood cell in the immune system. In CLL, the bone marrow produces too many lymphocytes.

How do you confirm diagnosis of leukemia? ›

How is leukemia diagnosed? A diagnosis of leukemia is usually made by analyzing a patient's blood sample through a complete blood count (CBC) or microscopic evaluation of the blood, or by using flow cytometry.

What are the CD markers for CLL? ›

CLL cells are characterized by high expression of CD5, CD19, and CD23 [2]. It seems that other markers, such as CD38, CD25, CD56, and CD117 may also have prognostic importance in CLL. As interleukin-2 (IL-2) receptor alpha chain, CD25 can be expressed in 30–50% of CLL patients.

Can CLL patients live 20 years? ›

CLL has a very high incidence rate in people older than 60 years. CLL affects men more than women. If the disease has affected the B cells, the person's life expectancy can range from 10 to 20 years.

What is the best treatment for CLL in 2022? ›

Among these new treatment options, the first-generation BTK inhibitor ibrutinib remains the preferred first-line treatment for CLL, although the second-generation BTK inhibitor zanubrutinib has been found to be comparable to ibrutinib.

How fast can CLL progress? ›

CLL is a slow-progressing form of cancer. It can take several years for symptoms to manifest. Doctors and researchers in the United States typically follow the Rai staging system, which classifies CLL into five stages , ranging from 0 to 4.

Can you live 30 years with CLL? ›

Chronic lymphocytic leukemia (CLL) can rarely be cured. Still, most people live with the disease for many years. Some people with CLL can live for years without treatment, but over time, most will need to be treated. Most people with CLL are treated on and off for years.

What causes death in CLL patients? ›

Infection causes death patients with CLL largely due to the dysregulation and deficiency of their immune system by the disease or by treatment. For example, defective T-cells and B-cells can increase the chances of infection, and immunosuppressive therapies can make patients more susceptible to infectious diseases.

Is CLL a terminal illness? ›

Generally, about 7 out of 10 people will survive their leukaemia for 5 years or more after being diagnosed. Younger, healthier people who are diagnosed when CLL is still in the early stages generally have the best outlook. Although it cannot normally be cured, treatment can help control the condition for many years.

What percentage of CLL patients need treatment? ›

Around 30-50% of people diagnosed with CLL never require any treatment for their disease and can survive for many years despite their diagnosis.

What happens if you leave CLL untreated? ›

If left untreated, you can develop serious complications from the disease such as anemia and symptoms such as fatigue and shortness of breath, bleeding and difficulty fighting off infections or frequent infections. In extreme circumstances you may need transfusions of blood or platelets prior to the diagnosis of CLL.

What does CLL pain feel like? ›

Bone pain can occur in leukemia patients when the bone marrow expands from the accumulation of abnormal white blood cells and may manifest as a sharp pain or a dull pain, depending on the location. The long bones of the legs and arms are the most common location to experience this pain.

Can leukemia be found in a routine blood test? ›

Your doctor will conduct a complete blood count (CBC) to determine if you have leukemia. This test may reveal if you have leukemic cells. Abnormal levels of white blood cells and abnormally low red blood cell or platelet counts can also indicate leukemia.

What age is CLL diagnosed? ›

CLL mainly affects older adults. The average age of people when they are diagnosed is around 70 years. It's rarely seen in people under age 40, and is extremely rare in children. Visit the American Cancer Society's Cancer Statistics Center for more key statistics.

What does leukemia look like on a CBC? ›

Leukemia is most often diagnosed through a diagnostic test called a complete blood count (CBC). If a patient's CBC shows abnormal levels of white blood cells or abnormally low red blood cells or platelets, he or she has leukemia. The physician will then order a bone marrow biopsy to determine the type of leukemia.


1. CLL: Mayo Clinic's approach to diagnosis
(Mayo Clinic)
2. Progress in CLL diagnosis and treatment
(VJHemOnc – Video Journal of Hematological Oncology)
3. Chronic Lymphocytic Leukemia (CLL) - What It Is, Causes, Symptoms, Treatments & More
4. Chronic lymphocytic leukaemia (CLL) symptoms & treatment – Meet Sid and Sue
(Janssen EMEA)
5. When to Initiate Therapy for Chronic Lymphocytic Leukemia
6. CLL: Mayo Clinic's approach to diagnosis
(Mayo Clinic)

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