What CLL Diagnostic Info Is Valuable Before Making Treatment Decisions?

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Topics include: What Is Chronic Lymphocytic Leukemia?

Before starting treatment for chronic lymphocytic leukemia (CLL), it’s important for doctors to classify your disease “subtype.” What tests are used to diagnose CLL?  How important is a bone marrow biopsy? Experts Dr. Jeff Sharman and Dr. Jeffrey Menashe discuss the tests and tools used to diagnose and detect the presence of genetic mutations in CLL. Watch now to learn more about these chronic lymphocytic leukemia diagnosis considerations. 

This town meeting is sponsored by Pharmacyclics LLC and Janssen Biotech, Inc. It is produced by Patient Power in partnership with The CLL Global Research Foundation, The US Oncology Network, Compass Oncology, Willamette Valley Cancer Institute and Research Center, and The Leukemia & Lymphoma Society (LLS).

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:          

So, making treatment decisions—so, first of all, I want to start with this, Jeff Sharman—CLL is not a one-size-fits-all. How do you know what version of CLL you have? 

Dr. Sharman:              

So, there are a number of important questions embedded in that. It’s a conversation that oftentimes comes up very early in the management of a patient who may come into your office just being told they have leukemia or—that’s actually a common presentation is, “My doctor told me I have leukemia.” There’s this kind of dazed and confused look. 

So, in those initial conversations, I always start with, “Okay, there are four main families of leukemia—there’s acute, there’s chronic, there’s myeloid, lymphoid, and it sort of makes a box plot with four different types.” So, we say you’re in CLL. Most of what you think with leukemia when you see children who are bald, who are really sick, that’s AML or ALL. So, CLL is just a different entity completely. 

I think we’re all conditioned to hear that early detection saves lives, early intervention leads to the best outcomes. That’s what I think the gestalt is when these patients walk into the room, like, “What kind of chemotherapy do I need?” You have to unwind this and say, “Well, you’ve got CLL but having CLL doesn’t mean you need to treat it. You can oftentimes live with CLL for a long time.” 

I often find it’s very reassuring when you go back and find some of these blood tests from four years prior and you say, “See this little lymphocytosis you had four or five years ago? You probably have had your CLL all this time and didn’t even know it.” 

So, when we talk about subtypes of CLL, we get into discussions about FISH testing and IGHV mutation analysis. It can quickly become very overwhelming. So, we kind of try to layer this in as we go. 

Andrew Schorr:          

We’ll walk through that as we go. The point is there’s different testing we do. Dr. Menashe, how important in 2019 with the testing we have—do have to do a bone marrow biopsy where you have to stick a needle in somebody’s hip to look at the cells? 

Dr. Menashe:              

Usually, we do not have to do that. I think we look at people who present with these high white blood, high lymphocyte counts. Usually, we can define it just by tests on the peripheral blood. Sometimes, there are some variants that occur, which sometimes you might have to do some ancillary tests, imaging or even bone marrow, but usually not.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on September 19, 2019