Is early treatment of chronic lymphocytic leukemia (CLL) effective?
In science and medicine, information is constantly changing and may become out-of-date as new data emerge. There is no evidence that early treatment is of any benefit in chronic lymphocytic leukemia (CLL). Treatment should be based on what is going on with us patients and in most cases not with our ALC (absolute lymphocyte count).
What is the WBC and ALC of a CLL patient?
Nine months after diagnosis, a fellow patient with CLL tells you that his WBC (white blood cell count) is 49,000 with an ALC (absolute lymphocyte count) of 42,000. He has clusters of 2 x 1 cm nodes in both axillae (armpits).
When should LDT not be used as the only criterion for treatment?
If ALC is <30,000, LDT should not be used as the only criterion for beginning treatment. The last indication for treatment, namely a rapidly rising ALC is controversial. Please note there is no absolute level of ALC that demands treatments.
How do you know what stage of CLL you are in?
Stage I: The patient has lymphocytosis and enlarged lymph nodes. The patient does not have an enlarged liver or spleen, anemia, or low levels of platelets. Stage II: The patient has lymphocytosis and an enlarged spleen and/or liver and may or may not have swollen lymph nodes.
What is the best treatment for CLL in 2021?
According to the American Cancer Society , doctors commonly prescribe the following medication combinations to treat CLL:acalabrutinib (Calquence) with Gazyva.alemtuzumab (Campath) with rituximab (Rituxan)bendamustine and Rituxan.chlorambucil and Rituxan.fludarabine, cyclophosphamide, and Rituxan.More items...•
Does early stage CLL always progress?
Every case of CLL is different, and it can be difficult to predict if and when your CLL will progress. Some people experience fast progression, while others go on for years without experiencing any new symptoms. People who are diagnosed at a higher stage of CLL are likely to progress at a faster rate.
When should you start treatment for CLL?
Doctors usually wait until there are signs the CLL is progressing before suggesting you have treatment. There is no evidence that starting treatment before this helps, and it can cause side effects. CLL usually develops very slowly, so you may not need treatment for months or years.
What is the newest treatment for CLL?
In May 2019, the FDA approved venetoclax (Venclexta) in combination with obinutuzumab (Gazyva) to treat people with previously untreated CLL as a chemotherapy-free option. In April 2020, the FDA approved a combination therapy of rituximab (Rituxan) and ibrutinib (Imbruvica) for adult patients with chronic CLL.
What is first line treatment for CLL?
Chemoimmunotherapy (CIT) has been the standard first-line therapy for CLL. Age and comorbidities can help decide which patients may benefit from a CIT approach. FCR (fludarabine, cyclophosphamide, and rituximab) is the current standard treatment option for younger patients with CLL.
What should be avoided in CLL?
Your CLL treatment may weaken your immune system and raise your chances of getting foodborne illness. These steps can help keep you safe: Cook meat until it's well-done and eggs until the yolks are hard. Avoid raw sprouts, salad bars, and unpasteurized drinks and cheeses.
What percentage of CLL patients never 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.
Can you live 20 years with CLL?
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 considered a high WBC for CLL?
A normal lymphocyte range for adults is anywhere between 1,000 and 4,800 cells in 1 microliter (μl) of blood. A diagnosis of chronic lymphocytic leukemia requires a lymphocyte level of greater than or equal to 5,000 B cells per μl for a minimum of 3 months.
What is a high WBC for CLL?
At the time of diagnosis, patients can have very, very high white blood cell counts. Typically a healthy person has a white blood cell count of about 4,000-11,000. Patients with acute or even chronic leukemia may come in with a white blood cell count up into the 100,000-400,000 range.
Does CLL always require treatment?
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 is the WBC of a CLL patient?
Nine months after diagnosis, a fellow patient with CLL tells you that his WBC (white blood cell count) is 49,000 with an ALC (absolute lymphocyte count) of 42,000. He has clusters of 2 x 1 cm nodes in both axillae (armpits). Labs are otherwise OK. He feels well, just a bit tired and stressed. He asks what symptoms or lab results might indicate it is time to treat. You tell him:
What is CLL in hematology?
Hematology in general and CLL specifically are full of jargon and acronyms that can be both overwhelming and daunting . With time and experience, you’ll become familiar with the terminology and acronyms. We will try to explain each medical term the first time it appears in an article, but we will use the true terminology so that you gain comfort and familiarity with the medical terms that you will see in your lab reports and in medical articles. We have also provided a glossary and a list of abbreviations and acronyms for your reference.
How long can you sweat without infection?
Fevers >38°C for at least 2 weeks without evidence of infection. Drenching night sweats for more than a month without evidence of infection.
Is Watch and Wait better than Chlorambucil?
In fact this famous study published in 1998 compared “Watch And Wait” to early intervention with chlorambucil, an oral chemotherapy and at that time the standard of care, and found that the group on chlorambucil fared slightly worse. Admittedly, we have much better treatments today.
Symptoms Indicate Need to Start Treatment
Generally, chronic lymphocytic leukemia is not treated until symptoms appear. Symptoms may include:
Ask Questions and Get a Second Opinion
No one ever wants to hear the words, “You have cancer.” But once you’ve received a diagnosis, it’s critical to be your own best advocate.
What happens when you have chronic lymphocytic leukemia?
Chronic lymphocytic leukemia occurs when your body produces abnormal lymphocytes, a type of white blood cell. These abnormal lymphocytes don’t function as white blood cells should to help your immune system. They also multiply faster and live longer. Over time, they can “crowd out” other healthy blood cells in your bone marrow, such as your red blood cells and platelets. The cancerous cells may travel through your blood to other organs, affect ing them as well.
What is the treatment for high white blood cells?
Another type of treatment, such as targeted therapy or chemotherapy, will still be needed afterwards.
Is CLL better tolerated?
The new stem cells then create new and healthy blood cells. Getting any kind of cancer diagnosis can be scary, but new treatments for CLL are often more effective and better tolerated than those of the past. With the addition of these novel therapies to the CLL treatment arsenal, the outlook looks brighter than ever.
Does leukemia improve life expectancy?
Several studies have shown treating chronic lymphocytic leukemia early in the disease process doesn’t improve your overall outcome or increase your life expectancy. And since most people don’t experience any symptoms in these early stages, there’s less of a benefit and more of a risk of side effects or complications from cancer treatment.
What is the mantra for CLL?
The " watch and wait " mantra in CLL can be a test of wills unlike most other cancer experiences. Let's face it, sitting there and doing, "nothing" is hard enough when we are conditioned to believe "early detection saves lives" or "catching it early is your best chance to beat it.". Those things are true in common cancers like breast, prostate, ...
How long does it take for a white blood count to go from 20 to 50?
It is one thing for a white blood count to go from 20 -30 - 50 - 80 over a two year period. It is another thing all together if that happens over four months. All too often, I hear people get anxious when the wbc goes from 30 to 50 without other changes.
Is 100 CLL different from 100 AML cells?
In some of the "acute leukemias" which are very different conditions - such numbers would be terrifying. The biology is very different though - 100 CLL cells is very different than 100 AML cells. So if we don't look at a single number - then what should we look at.
Is rituxan good for follicular lymphoma?
In follicular lymphoma, things are changing for the better. Rituxan is "biologic therapy" that is a pretty effective treatment that does not necessarily need to involve chemotherapy. 70% of patients will respond to rituxan and disease control can be quite durable for some patients.
