Diagnosing Chronic Lymphocytic Leukemia
It’s often an abnormal blood test result, not symptoms, that lead to a CLL diagnosis according to the Leukemia & Lymphoma Society. For example, your physician might notice a higher-than-normal white blood cell count from a blood sample taken during your annual physical exam. Further investigation might reveal CLL as the cause.
Most patients who have an abnormal blood test result without an obvious reason are seen by a hematologist. This doctor specializes in blood diseases, including blood cancers such as leukemia.
The hematologist is likely to order a complete blood count test. This will give an indication as to whether a high number of lymphocytes are present which could mean CLL.
Flow cytometry tests are likely to be done if the lymphocyte count is high. This tells the hematologist more about the reason for the high count and if CLL is present, it will give an indication of whether it’s aggressive or slower-growing.
If you’re diagnosed with chronic lymphocytic leukemia, another important step is to determine whether the disease has spread to the organs or lymph nodes. This is known as staging the cancer, and it helps your hematologist decide how to approach treatment.
Genetic tests may be run to look for gene mutations associated with chronic lymphocytic leukemia. The results of these tests can impact the types of treatments that are likely to work best.
A PET-CT scan helps the hematologist determine if there are areas where the cancer has spread but can’t be seen with the naked eye.
Chronic Lymphocytic Leukemia Treatments
Your cancer specialists will consider many factors when deciding how to treat chronic lymphocytic leukemia. These include your overall health, the stage of the disease, whether you’re experiencing symptoms, how quickly the cancer is progressing, and blood cell levels.
If Your CLL is Slow-Growing
If you don’t have symptoms, your team may recommend watchful waiting. In other words, you’ll receive close monitoring for any signs that the disease is progressing.
If you need active treatment, the first line of treatment usually includes a combination of a few different treatments. The right combination for each patient is based on the test results. If the first-line treatment isn’t effective, there are some other drug combinations that can be used. The drugs are divided into a few different categories:
Chemotherapy
Medication that travels through the blood to kill or impede the spread of cancer cells. The majority of patients can take oral chemotherapy as a part of their treatment regimens, instead of just IV-based drugs. If your tests showed high numbers of lymphocytes a process called leukapheresis may be needed to remove some of the abnormal lymphocytes before chemo begins. This allows for less chemo to be needed for it to be effective.
Monoclonal Antibodies
This type of drug can be referred to as a targeted therapy or an immunotherapy. That's because some of the monoclonal antibodies used to treat CLL have a specific target on a cancer cell that they aim to find, attach to, and attack. Other types of monoclonal antibodies help the immune system respond better to allow the body to find and attack cancer cells more effectively.
Other Immunotherapies and Targeted Therapies
These drugs may be selected in addition to or instead of monoclonal antibodies based on the specific genetic makeup of the cancer cells. There is extensive research under way for CAR-T immunotherapy treatments for leukemia patients.
Radiation Therapy
Radiation therapy for CLL is less common because there isn’t necessarily a single point where the radiation can be aimed. That’s because blood cancers run throughout the entire body. However, it can help reduce pain from swollen organs or enlarged lymph nodes.
If you have a type of chronic lymphocytic leukemia that is hard to treat or returns after treatment, you may need a stem cell transplant. The stem cells can come from your blood or bone marrow, or from a donor. A stem cell transplant can help replace bone marrow and blood cells lost to high-dose chemotherapy.
The team at Rocky Mountain Cancer Centers includes hematologists who specialize in CLL. They will help you evaluate when to start treatments since it’s often a slow-growing type of blood cancer. And, when the time comes for treatment, they will run the tests to determine which combinations are likely to work best for you. Clinical research is also available through RMCC which means the most recent treatment options may be available to you. Talk to your RMCC specialist about whether there is a trial that you qualify for.
