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Understanding Chronic Lymphocytic Leukemia of the Brain

Chronic lymphocytic leukemia (CLL) is a form of cancer of the blood and bone marrow, the spongy tissue inside bones where blood cells are made. CLL happens when a person’s bone marrow makes too many lymphocytes, a type of white blood cell.

According to the National Cancer Institute, when CLL metastasizes (spreads), it usually travels from the blood and bone marrow to the following parts of the body:

  • Lymph nodes
  • Liver
  • Spleen

How Can CLL Affect the Brain?

Rarely, CLL invades the fluid lining the brain and the brain itself, notes V.K. Gadi, MD, PhD, the deputy director at the University of Illinois Cancer Center in Chicago. “When cancer travels to the lining of the brain, it’s called meningeal carcinomatosis, and it’s a serious and potentially life-threatening complication,” he says.

If cancer metastasizes to another area of the body, it’s named after its original location, according to the American Cancer Society. So CLL that travels to the brain is still considered CLL, not brain cancer.

How Common Is CLL of the Brain?

According to a report and study review published November 30, 2018, in the medical journal Cureus, CLL that involves the central nervous system (including the brain) occurs in about 0.8 to 2 percent of patients. But research looking at autopsies of individuals with CLL suggests that the phenomenon is much more common and, perhaps, underdiagnosed. According to a report published in Clinical Lymphoma, Myeloma, & Leukemia, a large autopsy study found brain involvement in 20 percent of CLL cases.

CLL that spreads to the brain can occur anytime during the disease, notes the Cureus study.

Symptoms of CLL in the Brain

According to a study published in the January–April 2022 issue of Case Reports in Oncology, if CLL spreads to the brain, it may cause the following symptoms:

  • Headaches
  • Mental status changes, including brain fog
  • Cranial nerve abnormalities, which could cause vision problems
  • Weakness

The Mayo Clinic says some general symptoms of CLL (that hasn’t necessarily spread to other areas of the body) include:

  • Fatigue
  • Fever
  • Night sweats
  • Enlarged lymph nodes
  • Pain in the upper left part of the abdomen
  • Unexplained weight loss
  • Frequent infections

How Do Doctors Diagnose CLL in the Brain?

spinal tap procedure is the best way to determine if CLL has spread to the brain, according to Dr. Gadi. During a spinal tap, doctors insert a needle into the space between two vertebrae to remove a sample of fluid, explains the Mayo Clinic.

Other imaging procedures, such as magnetic resonance imaging (MRI), may also be used during the diagnostic process. But these tests may not be reliable. According to the Cureus review, only 32 out of 80 patients with CLL that had spread to the central nervous system had proven imaging findings.

Treatment Options for CLL That Has Spread to the Brain

Because CLL metastasis to the brain is so rare, doctors haven’t determined a standard treatment regimen for the condition, according to the Cureus review.

In the past, CLL that invaded the brain was exclusively treated with whole brain radiation or systemic chemotherapy. But Carlos Galvez, MD, an assistant professor of clinical medicine in the division of hematology and oncology at the University of Illinois in Chicago, says that most cases of CLL today are treated with targeted therapies, such as:

Targeted therapies work by focusing on specific changes inside cancer cells that trigger them to grow. They are different from chemotherapy in that they target specific proteins instead of destroying all the cells, according to the American Cancer Society.

"The advent of novel targeted therapies, such as BTK inhibitors (for example, ibrutinib) and BCL-2 inhibitors (such as venetoclax) have dramatically changed the treatment landscape of CLL and significantly improved survival in patients with this condition," notes Dr. Galvez.

The Clinical Lymphoma, Myeloma, & Leukemia report suggested that the following specific treatments may also be useful for treating CLL that has spread to the brain:

  • Corticosteroids and chemotherapy medicines, such as methotrexate and cytarabine
  • Liposomal cytarabine (a type of chemotherapy)
  • Fludarabine-based therapy (a treatment that slows the growth of cancer cells)

Sometimes, these medicines are administered into the spinal fluid.

What’s the Prognosis if CLL Invades the Brain?

The outlook for people with CLL of the brain varies and depends on different factors, such as the treatment they receive, their age, and their overall health.

The Cureus review found that the average survival rate for patients with CLL with central nervous system involvement was 3.79 years from the time of CLL diagnosis until death. In comparison, CLL patients without central nervous system involvement have an average survival rate of about six years.


https://www.everydayhealth.com/specialists/cancer/cll-of-the-brain-and-spreading-to-other-body-parts/

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