What Is Smoldering CLL?

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Topics include: Understanding

Dr. William Wierda, a world-renowned CLL expert from MD Anderson Cancer Center in Houston, defines smoldering CLL including an explanation of how it is diagnosed and monitored.

The Ask the Expert series is sponsored through an educational grant to the Patient Empowerment Network from Pharmacyclics, Inc.

 

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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.

Jeff Folloder:

We hear the term, "smoldering CLL."  What is smoldering CLL?

Dr. Wierda:

Well, smoldering CLL are individuals who have CLL, they have the parameters that qualify for a diagnosis of CLL. For example, they may have an elevated absolute lymphocyte count. They may have some lymph nodes that we can feel on physical exam. But it's—the patients—for these patients they don't have disease that's active or progressive.

So they may have some elevated absolute lymphocyte count that doesn't really change over time and is very stable. They may have lymph nodes that we can feel, but they don't change over time, or they may fluctuate some in terms of size, but in general the trend is for them not to increase.

And I have many patients who I've monitored for many years with disease that I can measure, but they don't—the numbers don't change. They feel well, and they don't need any treatment. And those are patients that one would refer to as having smoldering CLL.  It's there, we can measure it, but things aren't really changing.  The white count's not going up, the hemoglobin's not dropping, the platelet count's not dropping, and generally the lymph nodes aren't increasing.

Jeff Folloder:

And, in general, what percentage of the CLL population qualifies for this smoldering label?

Dr. Wierda:

Well, it's probably I would say 40 percent or so.  And the smoldering the—an individual's disease can be smoldering for a period of time and then become active, and they progress and need treatment.  So initially right after diagnosis, most patients have relatively smoldering disease in the initial period of their diagnosis.  Their counts might be changing, but we're not worried about starting them on treatment very soon.

They may be monitored for three or four years before they eventually develop indicators to start treatment.

So most patients at their initial diagnosis have smoldering disease, and the question a lot of times is whether or not somebody will transition from having smoldering disease into active progressive disease that needs to be treated.  But I would say maybe about a third of cases have many years of smoldering CLL and don't need treatment.

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 March 22, 2016