Watch and Wait: Can CLL Treatment be Delayed?
What is CLL?
The American Cancer Society defines chronic lymphocytic leukemia as: “the most common leukemia in adults. It's a type of cancer that starts in cells that become certain white blood cells (called lymphocytes) in the bone marrow. The cancer (leukemia) cells start in the bone marrow but then go into the blood.”
The cancerous cells spread from the bone marrow to the blood and can also affect the lymph nodes and other organs. CLL eventually causes the bone marrow to fail and weakens the immune system.
Approximately 21,040 people (12,930 men and 8,110 women) in the United States will be diagnosed with CLL this year. It’s more commonly diagnosed in older adults, with an average age of 70 years at the time of diagnosis. CLL is uncommon in people younger than 40.¹
What is Watch and Wait for CLL?
For patients diagnosed with CLL, some may need to start treatment immediately, while others can go with a “watch-and-wait” approach along with regular check-ins and blood work with their hematologist/oncologist.
With CLL, medical intervention becomes necessary if and when the disease progresses.
“I just saw a patient the other day who was diagnosed around year 2000 and came once a year and this is his 20-year anniversary in terms of not needing treatment. So that, obviously, is a very positive thing,” said Dr. Nitin Jain, Assistant Professor in the Department of Leukemia, Division of Cancer Medicine at the University of Texas MD Anderson Cancer Center.
“But certainly, I think we have patients in the clinic who were doing well for the first maybe five, ten years and then their disease has started to take off or their disease has started to progress a bit. So I think, the longer you go (without progressing), maybe the less risk you have,” Dr. Jain added during a conversation about the watch-and-wait approach with Patient Power Co-Founder Andrew Schorr.
CLL Prognostic Factors
Fluorescent in situ hybridization (FISH) is a process that vividly paints chromosomes or portions of chromosomes with fluorescent molecules to identify chromosomal abnormalities such as insertions, deletions, translocations, and amplifications.² These cytogenetic abnormalities can help your medical team determine an appropriate treatment strategy for you, like whether you are a candidate for chemotherapy.
Another indicator is IGHV mutational status.
“IGHV mutation analysis oftentimes helps us segregate between CLL that's more likely to be progressive versus not,” said Dr. Jeff Sharman, Medical Director of Hematology Research at US Oncology Network.
“It is a little bit of a forecasting marker looking into the future to see how it's going to behave. It does not change over the course of a patient's CLL, in contrast to FISH,” he added. “FISH is really quite dynamic and should be repeated with each new line of therapy. However, IGHV mutation analysis is stable through the course of somebody's CLL.”
CLL is variable and it’s important to understand the factors that are involved in getting you the specific care you need. As always, talk to your doctor to get the care that’s right for you.
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