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Since CLL is a cancer of the immune system, some of the most serious complications associated with CLL are related to immune dysfunction.
How to Cope with Our Reduced Immunity
The first complication is the reduced immunity CLL patients have to varying degrees.
We are more prone to infections, especially several types of pneumonia. All appropriate vaccinations should be considered soon after diagnosis and the flu shot annually. It is important to be zealous about hand washing. A well fitted mask and social distancing are recommended during the COVID-19 pandemic. In addition, avoid sick family and friends. and get “killed” vaccines. Furthermore, be aggressive about seeking medical care if we do get ill.
We also are at higher risk for other cancers, especially skin cancers. We need to get all the appropriate screening tests such as yearly skin checks, PAP smears, mammography, PSA and colon cancer check up.
We are also more prone to other blood cancers, either due to the CLL itself, or its treatment, especially after chemotherapy. These include MDS (myelodysplastic syndromes), a malignant form of bone marrow failure and Richter’s Syndrome, where the CLL transforms into a more aggressive type of lymphoma.
What’s more, we should do what we can to lower our health risk—Stop smoking, use sunscreen, and eat healthy foods.
The second complication is auto-immunity, when our own immune system turns against us. Although quite rare—only occurring in a few percent of all CLL patients—the consequences can be life threatening. The most common problem is when our immune system attacks our own red blood cells, causing anemia. This is known as auto-immune hemolytic anemia (AIHA). If we attack our own platelets, that is known as immune thrombocytopenic purpura (ITP). This can lead to bruising and bleeding problems. There are many good treatment options available for specifically treating AIHA and ITP directly. Often the CLL itself does not need to be treated to control these complications.
There are many other less common autoimmune complications as well. The takeaway message is that if we are anemic or our platelet count is low, we need to ask our doctors to consider respectively AIHA or ITP as part of the differential diagnosis.