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Treatment is not offered to chronic lymphocytic leukaemia (CLL) patients unless there is evidence of advanced or progressive disease. Patients with stable early stage CLL can be managed by regular simple review and often do not require treatment either at all, or for many years. Monitoring can often be done through the CLL Outreach (postal) clinic.
CLL is one of the chronic lymphoproliferative disorders, characterised by a progressive accumulation of functionally incompetent lymphocytes, which are monoclonal in origin. Early stage CLL is:
Early stage disease:
Other complications of CLL include:
Suspect an early stage chronic lymphocytic leukaemia if:
Examine for lymphadenopathy, hepatomegaly, and splenomegaly.
If there is a persistent lymphocytosis (more than 3 months), consider referral for immunophenotyping (surface markers) of peripheral blood lymphocytes according to the Lymphocytosis Pathway.
Ask about fever, weight loss (e.g. more than 10% in 6 months) and night sweats.
Review centres around
Patients should be seen by a haematologist and specialist nurse at diagnosis who can discuss topics such as prognosis, immunisation and immunoglobulin replacement, monitoring, current treatment approaches, concerns about family members being affected, practical issues such as insurance, quality of life impact. The word 'leukaemia' can generate significant anxiety which needs to be explored sensitively. These and other issues may require discussion on several occasions.
For more information see the Macmillan website.
Regular monitoring can be undertaken without hospital outpatient visits, which is generally more convenient for patients. This can be undertaken through blood tests at the GP surgery and concomitant return to the haematology department of a simple questionnaire. This also allows a route for rapid formal review if needed. Monitoring is usually 4 monthly for the first year, then 6 monthly to yearly if stable or slow, asymptomatic progression. This will be offered to most patients diagnosed through the haematology service.
Patients should be offered vaccination against Str. Pneumoniae (conjugate vaccine), H. Influenzae type B at diagnosis and annual vaccination against seasonal influenza and novel strains. Live vaccines such as polio, H. Zoster and yellow fever should be avoided.
If the patient is not being monitored through the haematology service request haematologist assessment if:
Urgent or written advice is available.
e-Referral Service Selection
This guideline has been signed off by NEW Devon CCG.
Publication date: July 2016