I think I once seen this asked. But, apparently, not much insight besides 'age' on causes of cll. Some have suggested that it can be certain medicines ; blood pressure, cholesterol, vitamin d pills..etc,. But others shot it down as unlikely, even though I can't find any studies refuting the link. And considering that cll usually effects older people, who also are more likely to be on some kind of meds, seems a probability that it can actually be the meds I mentioned, no?
Any insight as to CAUSES of cll besides 'age'o... - CLL Support
Any insight as to CAUSES of cll besides 'age'or 'genetics'?
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lankisterguyVolunteer
Hi LeeBic7,
We actually had a similar question 8 years ago (I found it in the "Related Posts box on this page): healthunlocked.com/cllsuppo...
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Although I didn't respond to that query, I have postulated my own theory that our immune system gets weaker as we age, and is affected by many different exposures and hereditary factors that affect our immune system. Our weak immune system does not detect malformed cells and destroy them promptly, so one or more cancers can develop. IMO whether we get CLL or other blood cancers or especially solid tumor cancers is pretty much a random occurrence.
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However this is not unique to CLL, it is for all cancers and even autoimmune diseases. But I am not medically trained and must refer to those who are: Below are the credible references I find for the causes of cancer:
who.int/news-room/fact-shee...
wcrf.org/diet-activity-and-...
cancer.gov/about-cancer/und...
cancer.org/cancer/risk-prev...
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Len
Exposure to carcinogens can cause cancer.
Here is a recent article published by Dr. Jennifer Brown talking about the origins of CLL. Ultimately, there is a lot we don’t know still.
Clinical Risks for Chronic Lymphocytic Leukemia
Author: Jennifer R. Brown MD, PhD
Volume/Issue: Volume 22: Issue 3
Online Publication Date: 06 Apr 2024
DOI: doi.org/10.6004/jnccn.2024....
“Conclusions
The causation of CLL remains poorly understood overall, with inherited risk being the most prominent risk factor, and environmental exposure likely involved as well, although the exact nature of the latter remains elusive. MBL is a precursor condition for CLL, but most people with MBL will not go on to develop CLL.”
Click on the PDF for an easier read. It isn’t too long or technical.
LeeBic7 -
I can't say that I recall seeing anything about particular drugs causing CLL.
One of the problems with chronic leukemias is that the original cell that mutated and divided many times to finally get noticed at diagnosis happened years before diagnosis. Most people don't have records to document exposure or consumption of specific things. Military people and people in certain trades do, though. So connections to the defoliant used in Viet Nam, Agent Orange, and the solvent, benzene, have documented connections in a percentage of people because they can compare people who worked in areas the chemical was used with people outside the areas. It's by no means 100% of the people exposed, though. So there has to be a larger story involving inherited genetics and even past diseases.
For a long time, scientists have looked for and failed to find a connection between CLL and EBV (Epstein Barr Virus) - the virus that causes mononucleosis. It infects B-cells. A documented connection between EBV and Burkitt Lymphoma has been proven down to a microbiology level. Again, it won't affect 100% of EBV victims, so the story is larger. Chronic malaria suppresses immune function in many of the victims of EBV in Africa, and some of them get Burkitt Lymphoma.
There are lawsuits regarding lymphoma and the weed killer, RoundUp, which contains a chemical called glyphosate. The proof of cause of CLL after using RoundUp is lacking, though there are lawyers who will help Americans join lawsuits to seek payments from the manufacturer, and some CLL patients have won. The standards of legal proof are far less than the standards of scientific proof.
Recently, the American Veterans Administration has allowed disability payments to veterans with leukemia and lymphoma for a variety of chemical exposures that include ingesting jet fuel in well water, inhaling gases and ash from pits where toxic metals and chemicals are burnt, as well as for a degreaser chemical called TCE (TriChloroEthylene). But the scientific causes have not been fully checked out.
=seymour=
in reply to SeymourB
Thank you so much for this info !
AussieNeilPartnerFounder Admin
CLL typically progresses from high count Monoclonal B cell Lymphocytosis (HC-MBL). As this paper notes, MBL becomes increasingly prevalent with age. "the prevalence of LC-MBL is much higher in the elderly population with a peak of 75% in persons above 90 years of age,"
The median age of diagnosis for CLL is around 70.
hindawi.com/journals/bmri/2...
Also, as the above paper notes, there's a genetic predisposition to developing CLL. That's considered to account for around 10% of cases.
Exposure to radiation was also found to be a risk factor, from studies following the Chernobyl event.
There's been suspicion about benzene exposure as well as some viruses, such as Epstein Barr, a very common human herpes virus.
Could you please share references to "blood pressure, cholesterol, vitamin d ". That's new to me. Of note, some studies have shown that a higher serum vitamin D level may be protective.
Neil
in reply to AussieNeil
Neil, I asked if those medicines MIGHT be a cause. I doubt there were any studies looking into if perhaps certain prescription drugs could cause cll, but I've seen some linking meds to other cancers.
Interestingly, after I was diagnosed I went back and looked at my 23 and Me health report and it showed a predisposition to CLL years before diagnosis. I was floored. I had seen the report years before but didn’t pay attention to it.
How did you know you had a predisposition to cll?My father died of leukaemia aged 45 in 1968. I didnt know that I had a chance of inheriting it or that it was cll. He had puemonia and pluracy. He was diagnosed 3 years before but he already had symptons. Boils under his arms that wouldnt heal and falling asleep.
There wasnt a cure in those days. I hope my family dont get cll.
Anne uk
I didn’t know I showed genetic markers that made me high risk for CLL until I went back and looked at results of my genetic testing on 23 and Me. You spit in a test tube and send it off and the company looks at your DNA for several things like ancestry. A lot of adopted people do it to try to locate family members. Remember that CLL is genetic but not necessarily inherited.
I have done a DNA test but not set up a direct debit yet. My father would have been 101 this year. He was brought up in a catholic childrens home by nuns. His mother had him there secretly. I dont want to meet his family but I would like to know about them. Cll and epilepsy are particularly of interest. He died of cll in 1968. I was 10.
J1015 -
My 23andMe did not show the predisposition variant detected. None of my sibs have been diagnosed yet, either. So I think I may have been exposed to something or am the victim of the randomness that rules the universe.
=seymour=
Genetic, not hereditary. 23 and Me saliva tests compare probability of having a disease compared with others with the same genetic markers. It marked me as high risk. I was so surprised. When I viewed it years ago, I paid no attention because I didn’t know what it was.
J1015 -
Variants on 23andMe are germline. They could be de novo mutations, but it's really unlikely.
De novo mutations in human genetic disease
Nature Reviews Genetics volume 13, pages 565–575
"Each generation (per individual), approximately 74 de novo single-nucleotide variants (SNVs), three novel indels (small insertions or deletions) and 0.02 larger copy number variants (CNVs) arise in our genome."
So it's possible the variant was de novo, but most likely inherited.
=seymour=
It only compares statistically with other people with similar genetics. It’s not a predictor. FDA made sure they make that clear so people don’t run around in a panic assuming they have or will have cancer.
J1015 -
Right. It's a matter of probabilities. Even if we have all the 23andMe identified variants, the probability is still low compared to BRCA1 and BRCA2.
=seymour=
J1015 -
I'm sorry, i missed the nuance on your answer regarding "genetic but not heteditary."
You're absolutely right in impky that CLL itself is not inherited like some cancers. It's a polygenic disease - many genes factor in. We can inherit the propensity, as 23andMe can show. But we don't inherit the disease directly.
Even the inherited cancers, like BRCA1 or BRCA2 breast cancer are at least somewhat polygenic. But the probability is much greater, so there are fewer genes involved.
=seymour=
References:
genome.gov/genetics-glossar...
Polygenic Trait
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yalemedicine.org/conditions...
Inherited Cancers
when i met my cll specialist and asked her this question her response was… “bad luck”
It cannot be proven that something doesn't cause cancer. That would be a logical fallacy. Only the existence of something can be proven. Not the non-existence.
Well I must be in the 10% genetics branch.. I was only 38 when diagnosed,15 years ago now. My Mum had it, diagnosed at 55, passed away at 60. My uncle (my Mums brother) had it also, diagnosed in his sixties, passed away at 72.
My Dad used alot of Roundup and other sprays including paraquat. I wonder if any connection to that and other chemicals sprayed in the area by farmers.
Who knows?! But am sure they may be a contributor. Too busy to worry about why I got it. Just doing my best to live as healthy as I can now to keep well,and hopefully not need further treatment for the CLL for a long time!
in our family it’s definitely genetic. 5 of us now in two generations. When I had treatment, a lot of the
People I seemed to meet had more than one relative with it.
I’ve always thought it was an element of genetics, then an individual trigger.
Hidden, my doctors admit they don't know for sure, but STRESS, has surfaced as a probability. It was in 2020, they curiously looked at the history of my annual wellness blood labs, it was noted that 2018 stuck out as when my WBC began to rise. I was asked what happened that year-oh, my! My husband and I were speechless and turned to stare at each other. That year was not a good year for our family-death and added concern for another family member. I was floored by the doctor's inquiry. That's when I was referred to a specialist for tests that showed CLL. So I immediately began to work on myself to beat down my worries and grief over what I have no control. Faith and prayer are my "weapons" and I must say I'm far better off in my thinking than I used to be. 😊Sandra
I too was under tremendous stress in the years leading up to my diagnosis. Stress can open up the door for bad things.
I am convinced excessive emotional & physical stress brought on, and now aggravates, my disease.
I have a very good dentist who for years kept on at me about trying to relieve my stress levels. She had done a lot of reading about what stress could do to our bodies as well as to our mental health. I was formally diagnosed aged 72. I don't know what my WBC levels prior were.
As we all do on diagnosis, we ask why me and is it hereditary? I had a conversation with my GP who pointed out that we generally don't know familial causes of death apart from very close family.
I've wondered occasionally about this subject. The village I live I has many public footpaths and I've used them for 28yrs with all my Golden Retrievers. Many many times I've set off on a circular the field I'm about to walk through is being sprayed and too late you can taste the chemicals it's in the air and frequently blowing in your direction. My home is surrounded by fields and wonder has this impacted me? Is there some of our genetics that make some of us more vulnerable to the consequences of Round Up spray? One of my Retrievers had Non Hodgkin Lymphoma and 2 farmers in the next village with CLL. Possibly pure coincidence I'll never know.
All cancer is caused by prolonged untreated inflammation in our body. The longer inflammation persists, the higher the probability that the cells will divide abnormally. When genetics and age are referred to as causes, these are more correlations than actual causes. Same with illnesses like high blood pressure or diabetes.
If you have an illness that is cause by poor genetics, old age, or a congenital defect, you can avoid developing cancer if it is well managed and the inflammation it causes is kept to a minimum. CLL is essentially a cancer of the immune system. If you have an immune system that doesn't function effectively, for example due to poor genetics or simply neglecting your own health, there is a higher probability that the cells will divide abnormally and become cancerous.
I am a layman, but work as an analyst, so my background is in science and statistics. Based on the research I've done while caring for my husband, this is what I've found the cause of CLL and cancer to be. We all get sick due to all sorts of issues, but we don't all develop cancer. From what I can tell, it I isn't entirely random. Some of us have underlying undiagnosed health issues that make us more susceptible to developing cancer, for example I have a variant blood type which makes it difficult for my body to properly absord nutrients. So, even though our blood tests may come back normal, we may still develop cancer later on due to these obscure health issues that doctors don't prescribe treatment for prophylacticly. And other times, we are just born with genetics that eventually cause our cells to go haywire.
It has been interesting to see the number of people diagnosed with cancer since the pandemic for example. It seems as though being exposed to a new illness can also exacerbate an underlying predisposition to cancer. All we can do it live as well as we can in our individual circumstances and advocate for ourselves when something doesn't feel right.
This is a big probability to me. Stress =inflammation, bad habits = inflammation.
I am more of the opinion the emotional "stress points" one received during the pandemic was perhaps more aggravating than the disease itself, although certainly both contributed.
psychologytoday.com/us/blog...
ncbi.nlm.nih.gov/pmc/articl...
sciencedirect.com/science/a...
Mental illnesses are certainly as detrimental to our health as physical illnesses and deserve the same level of resources and research. I would guess a significant proportion of us would be much healthier if we had better mental health support. Or better yet, if we weren't placed in situations that made us mentally unwell to begin with.
I had breast cancer, both sides, diagnosed originally in (late) 2001, with two surgeries on the left, several cycles of chemo and radiotherapy in 2002. Tumour on the right was found in 2008, followed by bilateral mastectomies. In between, my mother also had breast cancer, and my aunt also had it. The genetic testing did not show the two genes that have been associated with breast cancer, but the geneticist said that with the close cluster of cases in my family, it was likely that there was something else genetic going on that hadn't yet been identified.
Two years after being discharged as a cancer patient, I was diagnosed with CLL. Highly sus, if you ask me. However, I had the opportunity to ask Prof Chris Fox in person if there was a likely connection.. He thought not.
So I'm as stumped as everyone else! Please let us know if you find out.
I might not be ever able to prove it, but I feel that COVID caused mine. Had it once. At my next annual checkup white count was elevated for the first time.
This is what I think caused mine too
Hi were you vaccinated?
Yes
PennyLane, Anotherpuffin Phiphiminux , COVID-19 vaccines do not change cell DNA, so there's no mechanism by which they can cause cancer. See healthunlocked.com/cllsuppo...
Our cell nuclei are encapsulated by protective membrane within the cell. Messenger RNA comes out through narrow membrane channels to program protein manufacture - it's a one way process. Changes to cellular DNA require a means of getting the RNA through those channels followed by reverse transcription of the RNA back to the DNA and finally a means of editing the cell's DNA to include the new DNA.
Given you need more than 5 billion clonal B cells per litre to be diagnosed with CLL and an adult has about 5 litres of blood, that means that more than 25 billion CLL cells need to accumulate from the originating cancerous cell before you can be diagnosed with CLL - and that's assuming all the CLL is in your blood and not in the spleen, nodes and bone marrow, etc.
For something to cause CLL and be diagnosed within a year, you'd need a lymphocyte doubling time of around 10 days. So if a vaccination caused your CLL, why isn't your CLL still rapidly growing and needing treatment within days of being diagnosed? With a 10 day doubling time, your ALC would be 40 a month after diagnosis and 320 two months afterwards.
Neil
I don't believe the vaccine caused it. I was saying getitng a bout of COVID did.
A COVID-19 infection too, would have the same time constraints as a vaccine in showing up without the resulting CLL being extremely aggressive. Also unlike some viruses, I've not heard anything about SARS-COV-2 having the ability to enter a cell nucleus to change the DNA.
Hi (profile hidden)
I was diagnosed with CLL 2 1/2 years ago, aged 59, so older, but not really that old.👍
The meds I’d taken before diagnosis include: the occasional ibuprofen and…..🤔
That’s it, Not even vitamin supplements, got all my vit D naturally (from the sun).
I rarely got ill so didn’t need to take anything, so it’s not meds in my case.
My blood pressure and cholesterol have always been within range, so it’s not that.
I’ve always eaten relatively healthily, very little processed food, microwave diners or fast food so I doubt it’s that.
And in my case it’s not heraditary.
I’m not suggesting that I lived an exemplary lifestyle 😇.
I smoked, drank the occasional beer or six and could easily polish of the odd bottle of wine 😈.
But I was a healthy smoker (if that’s not an oxymoron), who didn’t get ill, only having a few days off in my whole working life and they were due to pulled muscles rather than illness.
Besides smoking, my work did bring me into contact with various carcinogens.
Chemicals in Monsanto in my teens and old engine oil, diesel fumes and other nasties since then, so they may be a contributing factor.
But why CLL rather than Lung cancer, which should have been much more likely, who knows, I guess I’m just lucky that way 🤪
The first thing I was told when I was diagnosed with CLL is, ”We don’t really know what causes it”, so it may be worth speculating, but It’s probably a combination of thing, or maybe it’s just faulty genes, so I don’t think it’s really worth me just guessing.
I’ll leave it to the experts 🤞.
Andy🏴
I had insane levels of exposure to methane chloride, paint, stripper, benzene,MEK by both inhalation and skin contact
Was just the nature of repairing ink manufacturing equipment
I do not have CLL. I have Multiple Myeloma (MM), actually, a very rare type of MM called MGRS. With MGRS the cancer attacks my kidneys. I find it interesting that there is a non-cancer pre-cursor to the CLL. With MM the precursor is called MGUS and is not considered cancer. I have had MGUS for over 20 years, diagnosed by accident on blood work. Science has always considered MGUS a benign condition. Now science is learning MGUS can carry significant ill health symptoms. I have been in ill health for over 20 years. I had a bone biopsy before starting chemo in January . I just completed four months of chemo and am scheduled for a stem cell transplant. I am frightened at what the stem cell will consist of, but am moving forward. The bone biopsy contained a test called a FISH study. The FISH study shows I have missing, bent, broken, mismatched chromosomes, especially the chromosomes involved in MM. I am considered "high risk", and was shown to be at risk of something called "double hit". I was told I was born with these bad chromosomes. So, is that why I have cancer? I was born that way! Why did I get MGUS? Was I also born with that? Or, was I born with bad chromosomes, and something happened to trigger the cancer. Or was I born with healthy chromosomes and something happened in childhood to cause the bad chromosomes. I grew up in an inner city just a couple of miles from an entire riverfront line of factories, including Monsanto and Purex. Who knows? I later moved to the country where crops were sprayed with herbicides and pesticides. There is a cluster of cancer, especially farmers with Leukemia , where I live. Or, is the cluster caused by the aging process. The farmers with Leukemia are mostly in their late 60s. I think the truth is that we just do not know. I know I have been exposed to so much nasty stuff, and I spent my life trying to avoid it. In the mid 90s I divorced and moved into a mobile home. I paid to put new carpet in the mobile home and immediately after the carpet was installed I became very ill. I ran a 101 degree fever for 5 months. I was tested for AIDS 7 times (it was the 90s). My health improved when I moved away. I remarried and we lived in the finished basement of our home while we built the upstairs. I became ill again from the mold in the basement. In the 1980s I lived in an old farm house. The previous owner had spilled something nasty, perhaps a pesticide, that still smelled bad over a decade later. And on and on and on, with exposure to the 21st century batting away at my chromosones and immune system. I wish I knew what caused my cancer, what caused such messed up chromosomes, but I just don't know. I do know the way the locals use the herbicide Round-up on their property i.e., fencerows and yards is terrifying. I also had cancer of the uterus in 2004, survived that.
Hello Hidden
Most of us CLLers have theories as to why me. If we could just find the cause, we could somehow reverse the course of CLL. I suspect that is the reason we search for food/herb that will reverse CLL, me included. We after all are what we eat. Unfortunately, there are as many theories as stars. Blessings on your search.
NewdawnAdministrator
’Hidden’ would appear to have now left the site so may not receive responses. However, the subject matter remains relevant and important to members.
Newdawn
I have no clue as to why I have CLL. I just do and life goes on
I like your attitude CycleWonder🙌
Keep in mind the ultimate cause of cancer is a mutation - the instructions within a particular cell get garbled in a particular way that changes the cell's DNA operating instructions in ways that enable unchecked proliferation of the cell. That's all cancer really is - one type of cells that run amok and do things they're not supposed to / grow places they're not supposed to grow / live longer than they're supposed to.
So what causes that mutation? The WHO article linked by lankisterguy sums it up well:
1) physical carcinogens, such as ultraviolet and ionizing radiation;
2) chemical carcinogens, such as asbestos, components of tobacco smoke, alcohol, aflatoxin (a food contaminant), and arsenic (a drinking water contaminant); and
3) biological carcinogens, such as infections from certain viruses, bacteria, or parasites.
As humans we try to impose control on a chaotic world, and so many people tend to fixate on 2) and 3), both as things to avoid so we "don't get cancer" and as potential curatives or palliatives once we do have cancer. And humans are generally terrible at risk assessment and correlation vs. causation. So we overdo it on the "find the cause" front. It's a subject of occasional controversy on this board.
But in the end, we have trillions of cells in the body, all of which are exposed to unfathomable amounts of ionizing radiation just living on a planet orbiting a star. When you play that many games of roulette, you're going to come up 00 sometimes. Sometimes it's a positive force - it drives evolution, after all. But sometimes it's a negative.
In the end, Sushibruno's oncologist has the right of it. "Bad luck" is pretty much the driver in the vast majority of cases.
You may have had unique exposure to Agent Orange or something else that has a proven statistical correlation with CLL. Even so, many people had that exposure and didn't get cancer. You just happened to hit the right combination to tip over a cell into cancerous state.
"Why does it happen? Because it happens. Roll the bones." - Neil Peart
Neil's book "Ghost Rider" played a huge role in my coming to terms with my diagnosis and the idea that bad things can happen to good people. Definitely worth a read, if you can find it.
Haven't read other responses, but herbicides, Roundup by Monsanto in US, has been shown to be a cause. Best to stay away from pesticides and herbicides. My aunt used them all the time for her roses and got Parkinsons which we think was from that.
The comments regarding Roundup are scientifically incorrect. As SeymourB mentioned, the legal proof and scientific proof are two different things. Attorneys are the only ones that state Roundup causation. Per the TV ads, I’m up to about 5 different “settlements” I’m eligible for 😜. ……
Hidden -
Given that > 75% of people over the age of 90 have MBL (Monoclonal B-cell lymphocytosis), and many of those have a type that progresses on to CLL or SLL, I think the genetic tendencies likely speed up an existing, inherent tendency.
It's just that most DNA doesn't code for a protein, so most mutations don't affect much of anything. And even when mutations happen inside genes, it doesn't always hurt them. Even if a cell mutates, if the mutation doesn't cause the cell to refuse to die on schedule, or if it doesn't make it grow faster, then cancer does not happen. So it's only the few genes out of 20,000 or so genes that affect life and death of the cell that make the difference.
A recent study looked at sequencing the whole genomes of lymphocytes in normal people, and found quite a few mutations called Copy Number Alterations, where entire genes or chromosomes are duplicated in some of the cells. These apparently don't have any effect on normal immune function (so far, at least).
ncbi.nlm.nih.gov/pmc/articl...
Low-frequency somatic copy number alterations in normal human lymphocytes revealed by large-scale single-cell whole-genome profiling
Genome Res. 2022 Jan; 32(1): 44–54.
"... we sequenced over 20,000 single lymphocytes from 16 individuals. Then, with the scale increased to a few thousand single cells per individual, we found that about 7.5% of the cells had large-size copy number alterations. Trisomy 21 was the most prevalent aneuploid event among all autosomal copy number alterations, whereas monosomy X occurred most frequently in over-30-yr-old females. "
It's much easier to do this sort of massive sequencing in blood than in solid organs.
Interestingly, Trisomy 21 in lymphocytes (that's indeed 21, not 12 - the same trisomy 21 that in other cells produces Down syndrome) has no apparent effect.
They also found occasional addition copies of or deletions of the X chromosome, which also had no effect on lymphocytes.
Lymphocytes and blood cells in general replicate extremely quickly - billions every minute. Other cells do not. Skin and the lining of the digestive system are quick, but not as quick as blood. I imagine that similar massive sequencing efforts on digestive cells will also show many harmless mutations - and the occasional cancerous one.
"Genomic alterations, including copy number alterations (CNAs) and point mutations, are the major drivers of many cellular malfunctions (Conrad et al. 2010; Sudmant et al. 2015). Tumor cells, for example, usually carry many CNAs and point mutations (Beroukhim et al. 2010; Waddell et al. 2015), many of which are oncogenic. After decades of study, researchers now recognize that point mutations accumulate in normal cells through polymerase replication errors and damaged DNA. Many point mutations barely affect cells, whereas others, located at critical locations, can transform cells (The Wellcome Trust Case Control Consortium 2010; Klopocki and Mundlos 2011). The scenario for CNAs in normal cells is less clear. Whereas large CNAs are extremely rare in humans, thus suggesting their destructive potential in cells (Zhang et al. 2009; Girirajan et al. 2011; Zarrei et al. 2015), their occurrences in normal cells may have been underestimated due to technical constraints."
So we can have several situations in a person:
1. Combine some inherited propensity that we know of from GWAS's (Genome Wide Association Studies) with the random errors, and we then see more CLL in some people.
2. Combine an inherited propensity with exposure to some chemicals, and we see CLL in other people.
3. But people without the inherited propensity can get CLL, too.
4. People exposed to the same chemicals or radiation may have different outcomes based on their own inherited and somatic (acquired mutations) genetics.
I would also wager a social security check that each FiSH type has a unique path of earlier mutations and events.
=seymour=
More References:
ncbi.nlm.nih.gov/pmc/articl...
Validation and functional characterization of GWAS-identified variants for chronic lymphocytic leukemia: a CRuCIAL study
Blood Cancer J. 2022 May; 12(5): 79.
---
ncbi.nlm.nih.gov/pmc/articl...
Do GWAS-Identified Risk Variants for Chronic Lymphocytic Leukemia Influence Overall Patient Survival and Disease Progression?
Int J Mol Sci. 2023 May; 24(9): 8005.
---
ncbi.nlm.nih.gov/pmc/articl...
Genetic Susceptibility to Chronic Lymphocytic Leukemia
Semin Hematol. 2013 Oct; 50(4): 10.1053/j.seminhematol.2013.09.007.
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