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Chronic Lymphocytic Leukemia Archive Questions

Below are Dr. Kimball’s answers to Chronic Lymphocytic Leukemia questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 9 of 9.


Q : 1

What is the treatment protocol for patients with CLL? My white blood cell count is 48,000 and has been stable for the last year. My bulky nodes need to be reduced, I have a distended abdomen, am developing pleural effusion and have 11Q deletion.

CLL is a dynamic area, with a variety of approaches. In general with large bulky nodes and effusion, treatment is indicated. With del 11q, we would recommend inclusion of Cyclophosphamide in the regimen, so FCR might be a good choice.

Q : 2

My husband, 71, has been diagnosed with CLL and the doctor said no treatment was needed and that he would probably die of old age before this became life-threatening. From our research, it seems that the prognosis is usually 5 years. We had hoped that it would be a lot longer than that. Does this sound like an appropriate course of action? Is the best prognosis only 5 years?

It sounds like you might be comforted by seeking a second opinion. CLL can follow a wide range of courses. About a third of newly diagnosed patients will never require treatment for their CLL. For others, the CLL progresses faster, and treatment is required. CLL can shorten a person's lifespan. Generally, a 71-year-old patient with newly diagnosed CLL should have their blood count checked every 2-3 months for the first year after diagnosis. If the white blood cell count doesn't rise too rapidly, and the platelet and red blood cell count stay high, then there is no need for treatment. After a year, monitoring can be extended to every 6-12 months.

Q : 3

Is follicular NHL is a hereditary cancer? Also does exposure to pesticides increase the chance for developing this disease?

We do not currently believe that lymphoma is a hereditary cancer. There is evidence that people who have exposure to pesticides develop Follicular Lymphoma more often than people without pesticide exposure.

Q : 4

In a bone marrow biopsy/aspiration, is it normal to have a bone marrow blood clot and what is reticulin fibrosis? Is it is normal to have some of that in bone marrow?

Physicians collect an aspirate and a biopsy, and some of us also collect a clot. The clot is similar to the aspirate, but handles a little differently, and can yield complementary information. Reticulin fibrosis is graded. Normal marrow has a low amount of fibrosis, but fibrosis can be increased to a degree that is pathologic, and can interfere with the production of normal blood cells.

Q : 5

I have been diagnosed with CLL (going on 10 years) and have been told that I am in stage 0. I am monitored every 6 months, but should I be monitored more frequently? A lot can happen within a 6 month time period. Also, recently I had a immunoglobin test done; Igg(380),Iga(47)and Igm (8). Should I be getting some type of treatment? Should I be getting any further testing?

After an initial close monitoring of CLL, every 6 months follow up is reasonable. CLL often follows the same, slow pattern for many years. CLL does sometimes accelerate in pace. If a CLL patient develops new symptoms, medical attention and a blood count check should be sought sooner than the scheduled follow ups. We do not usually base treatment decisions on the immunoglobulin levels. In cancer, it is always a good idea to get a second opinion. You need to feel confident about your choices. The Lymphoma Research Foundation, and, are good internet sources of CLL information.

Q : 6

I am a 27-year-old female who has had ongoing chronic swollen lymph nodes in my neck and armpits that come and go along with an elevated WBC count for six months. I have been on three antibiotics and nothing has helped and recently I noticed I have lost five pounds in less than a week along with low grade fever, chills and a strange rash. My doctor is sending me to a hematology/oncology specialist, is this necessary?

It is very important that you go to a hematologist. You should have an excisional lymph node biopsy done and evaluated by a hematopathologist.

Q : 7

I have enlarged lymph nodes under my arms and on my neck. Also, I have a strange feeling in my neck. I have been through many tests and antibiotics but nothing has improved. The nodes under my right arm are new and my doctor has suggested that I wait 2 weeks see if they go away despite seeing no changes in the other nodes. I'm not sure what to do and I am feeling frustrated. It's been going on for about 3 months now. What would you recommend?

I hope that you have nothing to worry about, but I think that your primary care doctor should initiate some evaluation. When we consider whether a person might have lymphoma, some of the blood tests that should be performed are: CBC with differential, LDH, EBV IgG and IgM, esr and crp. Lymph nodes that enlarge and don't subside after antibiotics should be evaluated. It would be appropriate for your doctor to make a referral to a medical oncologist. If the primary doctor chooses to do your blood work, the next step would be a CT scan of the neck and chest, and then a referral for a surgical biopsy.

Q : 8

My WBC reading is dropping from 23 and has stayed at 11.2 for the last five months. I initially took medicine called Augmentin in Oct 2009. My CBC report showed that my lymphocyte value was high. I was told the normal range is from 1-3 but mine has been 3.8 in the last two tests. Is this abnormal? Could my results indicate any kind of leukemia or lymphoma?

It sounds like you had an infection last year, and that your body responded appropriately, with a high white blood cell count. Now your lymphocyte count is 3.8, which is just a bit higher than what we call normal. What is important is that your lymphocyte count was high, and is now lower, and is stable over the last two readings. What we define as 'normal' for blood counts are a range that include 95% of all people - so there will always be some people whose numbers are a little higher or a little lower (just as some people are extra tall or extra short). So from what I hear of your blood counts, I am not at all worried about leukemia or lymphoma in you. To answer your last question -- if your lymphocyte count were consistently over 5.0, a hematologist might consider a possible diagnosis of Chronic Lymphocytic Leukemia. More tests would have to be done then to investigate the possibility.

Q : 9

I was just told about a month ago that I have cll stage 0. I am 53 years old and otherwise very healthy. My hematologic oncologist said I could live 30 yrs like this. I'm very worried. Should I be starting treatment?

I know this is a life-changing diagnosis. It is very difficult to live with a diagnosis of cancer. Many patients, especially those who are low risk like you, do have many years of not requiring treatment. I agree with your hematologist's plan for periodic monitoring of your blood levels. This is the current standard of care for Low Risk CLL.


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